1
|
Gill KS, Gupta B, Pooni PA, Bhargava S. Correlation of anterior cerebral artery resistive index with early comorbidities in preterm neonates. Front Pediatr 2024; 12:1441553. [PMID: 39328592 PMCID: PMC11424432 DOI: 10.3389/fped.2024.1441553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/05/2024] [Indexed: 09/28/2024] Open
Abstract
Introduction This study was undertaken to find the clinical correlation of resistive index (RI) in the anterior cerebral artery (ACA) of preterm neonates admitted to the Neonatal Intensive care unit (NICU) with comorbidities such as perinatal asphyxia, neonatal sepsis, and necrotizing enterocolitis (NEC). Methods An observational analytical study was conducted, including preterm neonates (<35 weeks) admitted to the NICU. Ultrasound cranium scans were performed on days 1-3 and 7 of life as per the study protocol. Baseline and clinical data of asphyxia, sepsis, and NEC were obtained. Images were acquired using a 4-8-MHz probe on a Sonosite M-turbo machine (Bothell, WA, USA). All statistical calculations were done using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA) with the application of the Kolmogorov-Smirnov test and the Mann-Whitney test. Results During the study period, a total of 739 neonates were admitted. Of these, 73 neonates constituted the study group. Among the 73 patients, 33 were preterm neonates without comorbidities and 40 neonates had comorbidities such as perinatal asphyxia, sepsis, and NEC stage 2 and 3 (necrotizing enterocolitis). In the present study, the mean RI on day 3 of life was 0.76 ± 0.04 in neonates without comorbidities and 0.77 ± 0.04 in neonates with comorbidities, with a p-value of 0.247. On the 7th day of life, the mean RI was 0.82 ± 0.03 in both groups, with a p-value of 0.42. Conclusion We could not find any significant clinical correlation of RI in the ACA of preterm neonates <35 weeks of gestation with comorbidities.
Collapse
Affiliation(s)
- Karambir Singh Gill
- Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
| | | | | | | |
Collapse
|
2
|
Richer EJ, Riedesel EL. Pediatric Cranial Ultrasound Revisited: A Comprehensive Review. Ultrasound Q 2024; 40:e00684. [PMID: 38991142 DOI: 10.1097/ruq.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
ABSTRACT Cranial ultrasound (CUS) is an indispensable tool in the evaluation of intracranial pathology in premature and term neonates and older infants. Familiarity with standard cranial ultrasound techniques and parameters, normal anatomy, and commonly encountered abnormalities is crucial for providing appropriate care for these patients. This review provides a comprehensive overview of cranial ultrasound in clinical practice.
Collapse
|
3
|
Becker AE, Dixon KL, Kirschen MP, Conlon TW, Glau CL. Advances in Point-of-Care Ultrasound in Pediatric Acute Care Medicine. Indian J Pediatr 2024:10.1007/s12098-024-05180-4. [PMID: 38842749 DOI: 10.1007/s12098-024-05180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Pediatric point-of-care ultrasonography (POCUS) has grown in utilization and is now an integral part of pediatric acute care. Applications within the pediatric critical care, neonatology and pediatric emergency were once limited to evaluation of undifferentiated shock states, abdominal free fluid assessments in trauma resuscitation and procedural guidance. The body of pediatric POCUS literature is ever expanding and recently published international consensus guidelines are available to guide implementation into clinical practice. The authors present a review of emerging applications and controversies within thoracic, hemodynamic, neurologic, and ocular POCUS in pediatric acute care medicine.
Collapse
Affiliation(s)
| | | | - Matthew P Kirschen
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas W Conlon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christie L Glau
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
4
|
You SK. Neuroimaging of Germinal Matrix and Intraventricular Hemorrhage in Premature Infants. J Korean Neurosurg Soc 2023; 66:239-246. [PMID: 37170495 PMCID: PMC10183255 DOI: 10.3340/jkns.2022.0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 05/13/2023] Open
Abstract
Germinal matrix and intraventricular hemorrhage (GM-IVH) are the major causes of intracranial hemorrhage in premature infants. Cranial ultrasound (cUS) is the imaging modality of choice for diagnosing and classifying GM-IVH. Magnetic resonance imaging (MRI), usually performed at term-equivalent age, is more sensitive than cUS in identifying hemorrhage in the brain. Post-hemorrhagic ventricular dilatation is a significant complication of GM-IVH and correlates with adverse neurodevelopmental outcomes. In this review, we discuss the various imaging findings of GM-IVH in premature infants, focusing on the role of cUS and MRI.
Collapse
Affiliation(s)
- Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| |
Collapse
|
5
|
Barakzai MD, Khalid A, Sheer ZZ, Khan F, Nadeem N, Khan N, Hilal K. Interobserver reliability between pediatric radiologists and residents in ultrasound evaluation of intraventricular hemorrhage in premature infants. World J Radiol 2022; 14:367-374. [PMID: 36483971 PMCID: PMC9723997 DOI: 10.4329/wjr.v14.i11.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/25/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Germinal matrix intraventricular hemorrhage (IVH) may contribute to significant morbidity and mortality in premature infants. Timely identification and grading of IVH affect decision-making and clinical outcomes. There is possibility of misinterpretation of the ultrasound appearances, and the interobserver variability has not been investigated between radiology resident and board-certified radiologist.
AIM To assess interobserver reliability between senior radiology residents performing bedside cranial ultrasound during on-call hours and pediatric radiologists.
METHODS From June 2018 to June 2020, neonatal cranial ultrasound examinations were performed in neonatal intensive care unit. Ultrasound findings were recorded by the residents performing the ultrasound and the pediatric attending radiologists.
RESULTS In total, 200 neonates were included in the study, with a mean gestational age of 30.9 wk. Interobserver agreement for higher grade (Grade III & IV) IVH was excellent. There was substantial agreement for lower grade (Grade I & II) IVH.
CONCLUSION There is strong agreement between radiology residents and pediatric radiologists, which is higher for high grade IVHs.
Collapse
Affiliation(s)
- Muhammad Danish Barakzai
- Department of Radiology, The Hospital for Sick Children, Toronto 555, Canada
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Ayimen Khalid
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Zara Za Sheer
- Community Health Sciences, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Faheemullah Khan
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Naila Nadeem
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Noman Khan
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Kiran Hilal
- Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
| |
Collapse
|
6
|
Cho HJ, Kim EJ, Son DW. Neonatologist-Performed Cranial Ultrasonography in the Neonatal Intensive Care Unit. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.
Collapse
|
7
|
Hwang M, Tierradentro-García LO, Hussaini SH, Cajigas-Loyola SC, Kaplan SL, Otero HJ, Bellah RD. Ultrasound imaging of preterm brain injury: fundamentals and updates. Pediatr Radiol 2022; 52:817-836. [PMID: 34648071 DOI: 10.1007/s00247-021-05191-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.
Collapse
Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Luis O Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Syed H Hussaini
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie C Cajigas-Loyola
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard D Bellah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
8
|
Impact of Medical Treatment of Hemodynamically Significant Patent Ductus Arteriosus on Cerebral and Renal Tissue Oxygenation Measured by Near-Infrared Spectroscopy in Very Low-Birth-Weight Infants. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040475. [PMID: 35454314 PMCID: PMC9033064 DOI: 10.3390/medicina58040475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/26/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
Background and objective: Hemodynamically significant patent ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes in preterm infants. Near-infrared spectroscopy (NIRS) allows us to continuously evaluate regional tissue oxygenation (rSpO2) and perfusion changes in underlying organs. The aim of this study was to evaluate the effect of medical treatment for hsPDA on cerebral and renal rSpO2 in infants less than 32 weeks of gestational age, and older than 72 h of life. Materials and methods: Infants with a gestational age of <32 weeks with hsPDA were prospectively studied before and during medical treatment. Two-site (cerebral and renal) rSpO2 monitoring by NIRS was performed 1 h before treatment (T0) and 24 h (T1), 24−48 h (T2), 48−72 h (T3) after the infusion of the first drug dose. Results: A total of 21 infants were studied. The mean day of life at treatment initiation was 8.2 (SD, 2.75). The DA diameter, LA/Ao ratio, and resistive index in the anterior cerebral artery (RI ACA) were significantly lower after treatment (p < 0.05). There were no significant differences in cerebral rSpO2, cerebral fractional tissue oxygen extraction (FTOE), and SpO2 comparing different time points. A significantly higher renal SpO2 value was recorded at T2 as compared with T0 (75.0%, SD 4.9%, vs. 69.4%, SD 7.6%; p < 0.013), while for renal FTOE, a tendency to lower values at T2 was observed (0.18, SD 0.05, vs. 0.24, SD 0.09; p = 0.068). Conclusions: Late (later than 7 days postpartum) hsPDA medical treatment with paracetamol or ibuprofen completely closed the duct only in a small proportion of preterm infants, despite a statistically significant reduction in the DA diameter, LA/Ao ratio, and RI ACA. Continuous renal, not cerebral, NIRS measurements can help to anticipate the efficacy of medical treatment of hsPDA in preterm infants. Large-scale prospective studies are needed to ascertain that renal and cerebral NIRS can be used as a reliable tool for evaluating the effectiveness of medical treatment for hsPDA.
Collapse
|
9
|
Superficial anatomy of the neonatal cerebrum - an ultrasonographic roadmap. Pediatr Radiol 2021; 51:353-370. [PMID: 33026469 PMCID: PMC7897227 DOI: 10.1007/s00247-020-04794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Neurosonography is an essential imaging modality for assessing the neonatal brain, particularly as a screening tool to evaluate intracranial hemorrhage, hydrocephalus and periventricular leukomalacia. The primary advantages of neurosonography include portability, accessibility and lack of ionizing radiation. Its main limitations are intrinsic operator dependence and the need for an open fontanelle. Neurosonographic imaging acquisition is typically performed by placing a sector transducer over the anterior fontanelle and following sagittal and coronal sweeps. The sensitivity of neurosonography has markedly improved thanks to the adoption of modern imaging equipment, the use of dedicated head probes, and the employment of advanced diagnostic US techniques. These developments have facilitated more descriptive identification of specific cerebral anatomical details, improving understanding of the cerebral anatomy by conventional US. Such knowledge is fundamental for enhanced diagnostic sensitivity and is a key to understanding pathological states. Furthermore, familiarity with normal anatomy is crucial for understanding pathological states. Our primary goal in this review was to supplement these technological developments with a roadmap to the cerebral landscape. We accomplish this by presenting a systematic approach to using routine US for consistent identification of the most crucial cerebral landmarks, reviewing their relationship with adjacent structures, and briefly describing their primary function.
Collapse
|
10
|
Aldrete-Cortez V, Tafoya SA, Ramírez-García LA, Poblano A. Habituation Alteration in Infants with Periventricular Echogenicity as an Indicator of Neurocognitive Impairment. Dev Neuropsychol 2021; 46:82-92. [PMID: 33393353 DOI: 10.1080/87565641.2020.1871482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Habituation difficulties may suggest neurocognitive impairment. Periventricular echogenicity (PVE) potentially causes subtle damage that poses neuropsychological risk. Habituation was evaluated through heart rate and behavioral states in infants at 36-37 weeks of corrected age between control and PVE groups. PVE infants showed early alertness and abrupt changes in behavioral states. However, the comparison group could better regulate their states. Heart rate was significantly high and remained unchanged in the PVE group but decreased in the control group. Alterations during the habituation paradigm in PVE infants could be early indicators of neuropsychological risk impairment. Scope of early habituation assessment is discussed.
Collapse
Affiliation(s)
- Vania Aldrete-Cortez
- Laboratory of Neuroscience and Cognitive Development, School of Psychology, Universidad Panamericana , Mexico City, Mexico
| | - Silvia A Tafoya
- Department of Psychiatry and Mental Health, School of Medicine, Universidad Nacional Autónoma de México (UNAM) , Mexico City, Mexico
| | - Luz A Ramírez-García
- Department of Neonatology, Hospital of Gynecology and Obstetrics "Dr. Luis Castelazo Ayala," IMSS , Mexico City, Mexico
| | - Adrián Poblano
- Laboratory of Cognitive Neurophysiology, National Institute of Rehabilitation, Clinic of Sleep Disorders, National University of Mexico (UNAM) , Mexico City, Mexico
| |
Collapse
|
11
|
Vitale V, Rossi E, Di Serafino M, Minelli R, Acampora C, Iacobellis F, D'Errico C, Esposito A, Esposito F, Vallone G, Zeccolini M. Pediatric encephalic ultrasonography: the essentials. J Ultrasound 2020; 23:127-137. [PMID: 30552663 PMCID: PMC7242593 DOI: 10.1007/s40477-018-0349-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/04/2018] [Indexed: 12/14/2022] Open
Abstract
Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using the natural fontanelles, especially the anterior one. It is fast, non-invasive and does not produce any side effect. Ultrasonographic examination is usually performed in cases of prematurity, especially in children with birth weight less than 1500 g, because important informations about the possible presence of pathologies such as cerebral hemorrhage and hypoxic-ischemic encephalopathy are given. This approach can be useful also in the study of pre- and post-natal infections, for example, type II Herpes Simplex virus or Cytomegalovirus infections, or pointing out vascular malformations such as vein of Galen aneurysm. Although less important than methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of trauma and tumors, ultrasound can provide useful informations or be used in first instance in the suspicion of a brain mass.
Collapse
Affiliation(s)
- Valerio Vitale
- Department of Diagnostics-Neuroradiology Unit, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
| | - Eugenio Rossi
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | | | - Rocco Minelli
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Ciro Acampora
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | | | - Chiara D'Errico
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Aniello Esposito
- Radiology Department, Legnano Hospital, ASST Ovest Milanese, Legnano, Italy
| | - Francesco Esposito
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy
| | - Massimo Zeccolini
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| |
Collapse
|
12
|
Oliver V, Bundi L, Mwango G, Mulama B. Clinical neonatal hypoxic ischemic injury: Cranial ultrasound spectrum of findings in neonates admitted to a Newborn Unit in Nairobi, Kenya. WEST AFRICAN JOURNAL OF RADIOLOGY 2020. [DOI: 10.4103/wajr.wajr_17_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Diwakar RK, Khurana O. Cranial Sonography in Preterm Infants with Short Review of Literature. J Pediatr Neurosci 2018; 13:141-149. [PMID: 30090126 PMCID: PMC6057202 DOI: 10.4103/jpn.jpn_60_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Premature newborn infants are exposed to a wide spectrum of brain lesions which are clinically silent supporting a possible role of cerebral ultrasound screening. Aim of the study is to describe the pattern of cranial ultrasound abnormalities in preterm infants defining the short term and long term neurologic outcomes. Material and Methods: A hospital-based bedside cranial ultrasound was carried out at day 1, 3, 7 and follow-up scan at 3-6 months in the Department of Radio-diagnosis. Results: One hundred infants were included. The different abnormalities detected in cranial ultrasound of premature newborn infants include hydrocephalus in 12%, intracranial hemorrhage in 6%, brain edema in 6%, periventricular leukomalacia in 2%, choroid plexus cyst in 1%, intraventricular septa in 1% and colocephaly in 1%. Conclusion: Gestational age, newborn birth weight and neurologic symptoms were the most important risk factors for detecting brain lesions. The main purpose of cranial ultrasound was the demonstration or exclusion of an intracranial hemorrhage in a preterm neonate.
Collapse
Affiliation(s)
- Rajendra K Diwakar
- Department of Radio Diagnosis, CCM Medical College and Hospital, Kurud Road, Kachandur, Durg, Chhattisgarh, India
| | - Omesh Khurana
- Department of Paediatrics, CCM Medical College and Hospital, Kurud Road, Kachandur, Durg, Chhattisgarh, India
| |
Collapse
|
14
|
Snyder E, Hwang M, Soares BP, Tekes A. Ultrasound and CT of the posterior fossa in neonates. HANDBOOK OF CLINICAL NEUROLOGY 2018; 154:205-217. [PMID: 29903440 DOI: 10.1016/b978-0-444-63956-1.00012-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ultrasound, CT and MRI may all be used in the evaluation of the posterior fossa in neonates depending on the clinical scenario. Ultrasonography is particularly valuable for the evaluation of the neonatal brain because of the lack of ionizing radiation and the ability to perform exams at the bedside and, importantly, advancements in ultrasound technology now allow for diagnostic-quality imaging. While CT is still the initial imaging modality of choice in most neurologic emergencies, in the neonate, ultrasound is the first line in nontraumatic emergencies. The goal of this chapter is to discuss the ultrasound technique for evaluation of the cerebellum, to describe the normal sonographic and CT appearance of posterior fossa and to provide the classical findings of the most common cerebellar abnormalities. While ultrasound is able to accurately diagnosis a majority of cerebellar abnormalities in neonates, subsequent MR imaging remains essential to confirm findings and to detect associated abnormalities.
Collapse
Affiliation(s)
- Elizabeth Snyder
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Misun Hwang
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Bruno P Soares
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Aylin Tekes
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| |
Collapse
|
15
|
Kim YJ, Choi YH, Cho HH, Lee SM, Park JE, Cheon JE, Kim WS, Kim IO. Comparison between 3-dimensional cranial ultrasonography and conventional 2-dimensional cranial ultrasonography in neonates: impact on reinterpretation. Ultrasonography 2017; 37:63-70. [PMID: 28780784 PMCID: PMC5769951 DOI: 10.14366/usg.17009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/25/2017] [Accepted: 05/28/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose The aim of this study was to evaluate impact of 3-dimensional cranial ultrasonography (3DUS) on reinterpretation of cranial ultrasonography images in neonates in comparison with 2-dimensional cranial ultrasonography (2DUS). Methods We retrospectively enrolled 50 young infants who simultaneously underwent both 2DUS and 3DUS scanning from February to March 2015. Two pediatric radiologists independently reviewed both scans for overall image quality on a 5-point scale. Five features were evaluated in both scans: the presence of germinal matrix hemorrhage (GMH), intraventricular hemorrhage (IVH), ventriculomegaly (VM), abnormality of periventricular echogenicity (PVE), and focal parenchymal lesions (FL). The concordance rate between the two scanning modes was calculated. The confidence level for each finding on a 3-point scale and the scanning time were compared between the two scanning modes. Interobserver agreement was evaluated using kappa statistics. Results Both scans demonstrated similar overall image quality in terms of reinterpretation (mean scores for 2DUS and 3DUS, 4.0±0.5 and 4.0±0.7 in reviewer 1, 3.9±0.6 and 4.0±0.8 in reviewer 2, respectively). GMH, IVH, VM, and FL showed perfect concordance, while PVE showed a concordance rate of 91.4% between the two modes by both reviewers. 3DUS was associated with a higher diagnostic confidence in the evaluation of GMH, IVH, and FL than 2DUS (P<0.05) for both reviewers. For PVE, 3DUS received a significantly higher confidence score than 2DUS from one of the reviewers. The mean scanning time for 2DUS and 3DUS was 92.75 seconds and 36 seconds, respectively. Interobserver agreement for qualitative scoring was almost perfect. Conclusion In reinterpretation, 3DUS showed very high concordance with 2DUS and a similar image quality. 3DUS also increased diagnostic confidence for several image findings and significantly decreased scan time.
Collapse
Affiliation(s)
- Yu Jin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Young Hun Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Hae Cho
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Ji Eun Park
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - In-One Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Diagnosis of an Intraventricular Cyst Using Point-of-Care Cranial Ultrasound in the Pediatric Emergency Department. Pediatr Emerg Care 2017; 33:216-218. [PMID: 28248763 DOI: 10.1097/pec.0000000000001052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 2-month-old previously healthy male infant presents with 2 days of unusual eye movements and increased fatigue. During evaluation in the pediatric emergency department, point-of-care cranial ultrasound identified a cyst-like mass. Subsequent magnetic resonance imaging confirmed the presence of a cyst within the third ventricle causing obstructive hydrocephalus.
Collapse
|
17
|
Gupta N, Grover H, Bansal I, Hooda K, Sapire JM, Anand R, Kumar Y. Neonatal cranial sonography: ultrasound findings in neonatal meningitis-a pictorial review. Quant Imaging Med Surg 2017; 7:123-131. [PMID: 28275563 DOI: 10.21037/qims.2017.02.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neonatal bacterial meningitis is a common manifestation of late onset neonatal sepsis. Cranial sonography (CRS) has a crucial role in assessment of infants with clinical suspicion of bacterial meningitis as well as follows up of its complications. CRS is performed with high frequency transducer through anterior fontanelle in both coronal and sagittal planes. Various sonographic findings range from echogenic and widened sulci, ventriculomegaly, ventriculitis, hydrocephalus, extra-axial fluid collections, cerebritis and brain abscess. Sonography is extremely beneficial in evaluating intraventricular contents, especially debris and intraventricular septations. Linear high frequency probe along with color Doppler interrogation are of utmost importance in evaluating extra-axial fluid collection and helps differentiating it from benign subarachnoid space enlargement. Due to low cost, easy portability, speed of imaging, no need for sedation and above all lack of ionizing radiation make it superior to other cross sectional imaging, like CT and MRI, in evaluation of these sick neonates. Apart from textbooks, there is paucity of recently available literature on cranial sonographic findings in neonatal meningitis. This article is written with an educational intent to review the spectrum of findings in neonatal meningitis, with stress on findings that will be beneficial in the clinical practice.
Collapse
Affiliation(s)
- Nishant Gupta
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Hemal Grover
- Department of Neuroradiology, NYU Lagone Medical Center, New York, NY, USA
| | - Itisha Bansal
- Department of Anesthesiology, New York Methodist Hospital, Brooklyn, New York, USA
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Joshua M Sapire
- Department of Neuroradiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Rama Anand
- Department of Pediatric Radiology, Kalawati Saran Children Hospital, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Yogesh Kumar
- Department of Neuroradiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| |
Collapse
|
18
|
Humsene K, Krishnaveni N, Sarada B. Transcranial Perinatal Neurosonogram for Intracranial Pathology: Study of 165 Cases. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2016. [DOI: 10.46347/jmsh.2016.v02i02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
19
|
Gupta P, Sodhi KS, Saxena AK, Khandelwal N, Singhi P. Neonatal cranial sonography: A concise review for clinicians. J Pediatr Neurosci 2016; 11:7-13. [PMID: 27195026 PMCID: PMC4862295 DOI: 10.4103/1817-1745.181261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cranial sonography continues to hold an important place in neonatal care. Attributes favorable to sonography that make it almost indispensable for routine care of the newborn includes easy access, low cost, portability, lack of ionizing radiations and exemption from sedation or anaesthesia. Cranial sonography has highest impact in neonates suspected to have meningitis and its complications; perinatal ischemia particularly periventricular leukomalacia (PVL); hydrocephalus resulting from multitude of causes and hemorrhage. Not withstanding this, cranial sonography has yielded results for a repertoire of indications. Approach to cranial sonography involves knowledge of the normal developmental anatomy of brain parenchyma for correct interpretation. Correct technique, taking advantage of multiple sonographic windows and variable frequencies of the ultrasound probes allows a detailed and comprehensive examination of brain parenchyma. In this review, we discuss the technique, normal and variant anatomy as well as disease entities of neonatal cranial sonography.
Collapse
Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
20
|
Wani NA, Qureshi UA, Ahmad K, Choh NA. Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases. AJNR Am J Neuroradiol 2016; 37:1535-40. [PMID: 27056426 DOI: 10.3174/ajnr.a4756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/20/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Brain imaging is central to the diagnosis of infantile encephalitic beriberi. Because cranial sonography findings have not been described in infantile encephalitic beriberi, our aim was to investigate its role in the diagnosis of this condition. MATERIALS AND METHODS We performed a retrospective review of head sonography of infants (admitted between November 1, 2014, and March 31, 2015) who presented with encephalopathy. Cranial ultrasonography scans were studied for the alteration of echogenicity of the basal ganglia. RESULTS Of the 145 consecutive infants who presented with encephalopathy, 58 had thiamine-responsive encephalopathy (infantile encephalitic beriberi) and 87 had encephalopathy due to other causes. Forty-eight of 145 infants with encephalopathy showed hyperechoic basal ganglia. A hyperechoic appearance of the basal ganglia on cranial ultrasonography was found to have a sensitivity of 71% (41/58) and a specificity of 92% (80/87) in diagnosing infantile encephalitic beriberi. The sensitivity of cranial sonography increased with age. It was a maximum of 93% (14/15) in the 5 months and older age group. Specificity was a maximum of 100% (18/18) in infants older than 5 months of age. Sensitivity was maximum in Wernicke encephalopathy at 90% (18/20) and least in the acidotic form at 43% (10/23). Follow-up showed gradual normalization of the hyperechoic appearance of the basal ganglia during 8 weeks in 26/41 (63%), with mild atrophy of the basal ganglia in 6/41 (15%) CONCLUSIONS Hyperechogenicity of the basal ganglia on cranial ultrasonography is a sensitive finding for the diagnosis of infantile encephalitic beriberi in infants who present with Wernicke encephalopathy.
Collapse
Affiliation(s)
- N A Wani
- From the Departments of Pediatric Radiology (N.A.W.)
| | - U A Qureshi
- Pediatrics (U.A.Q., K.A.), Government Medical College, Srinagar, Jammu and Kashmir, India
| | - K Ahmad
- Pediatrics (U.A.Q., K.A.), Government Medical College, Srinagar, Jammu and Kashmir, India
| | - N A Choh
- Department of Radiology (N.A.C.), SheriKasmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
21
|
Color Doppler ultrasonography in full term neonates with hypoxic ischemic encephalopathy and prediction of outcome. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
22
|
Ecury-Goossen GM, Raets MMA, Camfferman FA, Vos RHJ, van Rosmalen J, Reiss IKM, Govaert P, Dudink J. Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus. Pediatr Radiol 2016; 46:1291-300. [PMID: 27259991 PMCID: PMC4943974 DOI: 10.1007/s00247-016-3615-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/13/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about cerebral artery resistive index values in infants born extremely preterm. OBJECTIVE To report resistive index values in various cerebral arteries in a prospective cohort of preterm infants born at <29 weeks' gestation, and to compare resistive index in these arteries and assess the relationship between resistive index and hemodynamically significant patent ductus arteriosus. MATERIALS AND METHODS Using Doppler imaging, we obtained resistive index values of internal carotid arteries, basilar artery, anterior cerebral artery, and pial and striatal arteries in the first 3 days of age and weekly thereafter until discharge or death. We analyzed paired observations using the Wilcoxon signed-rank test, between-group comparisons with the Mann-Whitney test. RESULTS We performed 771 examinations in 235 infants. Resistive indices differed among arteries: vessels with larger diameters showed significantly higher resistive indices. Resistive index in infants without patent ductus arteriosus was lower than that in infants with hemodynamically significant patent ductus arteriosus (median in anterior cerebral artery: 0.75 and 0.82, respectively; P<0.001), though this was not statistically significant in all arteries. There was no difference in pre- and post-ligation resistive indices in infants who underwent patent ductus arteriosus ligation. CONCLUSION For accurate follow-up and comparison of cerebral artery resistive index, the same artery should be examined on each occasion.
Collapse
Affiliation(s)
- Ginette M Ecury-Goossen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Marlou M A Raets
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Fleur A Camfferman
- Department of Pediatrics, Division of Neonatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rik H J Vos
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
- Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
- Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| |
Collapse
|
23
|
Abstract
Neurosonography is a simple, established non-invasive technique for the intracranial assessment of preterm neonate. Apart from established indication in the evaluation of periventricular haemorrhage, it provides clue to wide range of pathology. This presentation provides a quick roadmap to the technique, imaging anatomy and spectrum of pathological imaging appearances encountered in neonates.
Collapse
Affiliation(s)
- Venkatraman Bhat
- Departments of Radiology and Imaging Services, Narayana Health, Bangalore, Karnataka, India
| | - Varun Bhat
- Departments of Radiology and Imaging Services, Narayana Health, Bangalore, Karnataka, India
| |
Collapse
|
24
|
Dinan D, Daneman A, Guimaraes CV, Chauvin NA, Victoria T, Epelman M. Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging. Semin Ultrasound CT MR 2014; 35:627-51. [DOI: 10.1053/j.sult.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
25
|
Pekcevik Y, Ozer EA, Guleryuz H. Cranial sonography in extremely preterm infants. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:283-290. [PMID: 24585484 DOI: 10.1002/jcu.22143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/25/2013] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
Survival rates of extremely preterm infants have risen dramatically, paralleling improvements in prenatal and neonatal care. Cranial sonography is the primary imaging technique for the evaluation of brain injury in these patients. Extremely preterm infants have some unique features related to ongoing maturation, and associated findings on cranial sonography should be considered for accurate and early diagnosis. The aim of this pictorial essay is to illustrate normal anatomy, normal variants, and pitfalls that lead to misinterpretation of cranial sonography in extremely preterm infants.
Collapse
Affiliation(s)
- Yeliz Pekcevik
- Izmir Tepecik Training and Research Hospital, Radiology Clinic, Gaziler Cd. No. 468, Yenişehir TR-35110, Izmir, Turkey
| | | | | |
Collapse
|
26
|
Wilke M. Gehirnentwicklung. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-012-2753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
27
|
Soudack M, Jacobson J, Raviv-Zilka L, Ben-Shlush A, Kuint J. Cerebellar hemorrhage in very low birth weight premature infants: the advantage of the posterolateral fontanelle view. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:395-401. [PMID: 23804360 DOI: 10.1002/jcu.22067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 12/02/2012] [Accepted: 04/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of cerebellar hemorrhage in very low birth weight infants using the posterolateral fontanelle for ultrasound (US) examination. METHODS The study included 125 very low birth weight premature infants (defined as equal or less than 1500 grams at birth) hospitalized in the premature or neonatal intensive care departments that had at least one head US examination including both anterior and posterolateral fontanelle scans. RESULTS On US performed through the posterolateral fontanelle, four (3.2%) infants had echogenic posterior fossa lesions interpreted as hemorrhages. None of these lesions were initially or retrospectively observed through the standard anterior fontanelle scan. Two infants died at age 4 and 39 days, respectively. All survivors are being followed up in the hospital's neurodevelopment outpatient clinic. CONCLUSIONS Cerebellar hemorrhage may be overlooked on standard anterior fontanelle views. The posterolateral approach may assist in diagnosing these lesions.
Collapse
Affiliation(s)
- Michalle Soudack
- Pediatric Imaging, Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | | | | | | | | |
Collapse
|
28
|
Mandiwanza T, Saidlear C, Caird J, Crimmins D. The open fontanelle: a window to less radiation. Childs Nerv Syst 2013; 29:1177-81. [PMID: 23516042 DOI: 10.1007/s00381-013-2073-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 02/27/2013] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Over the years, there has been increasing awareness of the radiation doses from medical investigation and treatment modalities and the long-term effect of this radiation. In no other patient population is this more of an issue than in the paediatric population who are more radiosensitive and have a longer life span in which to express any negative effects of radiation. In children under the age of one, the anterior fontanelle is an acoustic window to intracranial structures allowing for the use of cranial ultrasound (CRUSS) instead of CT. AIM To determine the pattern of CT and Cranial ultrasound used in patients aged one or younger with shunt treated hydrocephalus. METHODS A retrospective review of patients who had a shunt inserted before the age of one and their imaging. Effective radiation doses were calculated for those who had CT scans. RESULTS One hundred thirty-five patients were included with 227 CTs and 124 CRUSS conducted. In the follow-up period after shunt insertion, 92 patients had CTs while 14 were followed with CRUSS and 51 patients required a shunt revision before the age of one. The average effective radiation dose per scan was 2.76 mSv. CONCLUSION Children with an open fontanelle and shunt can be followed reliably with CRUSS in order to reduce their exposure to radiation.
Collapse
Affiliation(s)
- Tafadzwa Mandiwanza
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Republic of Ireland.
| | - Colm Saidlear
- Department of Radiology, Children's University Hospital, Temple Street, Dublin 1, Republic of Ireland
| | - John Caird
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Republic of Ireland
| | - Darach Crimmins
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Republic of Ireland
| |
Collapse
|
29
|
Miller E, Daneman A, Doria AS, Blaser S, Traubici J, Jarrin J, Moineddin R, Moore A, Shroff M. Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography. Pediatr Radiol 2012; 42:1070-9. [PMID: 22532234 DOI: 10.1007/s00247-012-2393-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease. OBJECTIVE To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV). MATERIALS AND METHODS Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10 h (mean, 3.5 h, range, and 2-7.6 h) of the MRI study using a standard protocol. RESULTS Fifty consecutive neonates participated in the study (30 males [60%]; 25-41 weeks old; mean, 37 weeks). The mean time interval between the date of birth and the CDUS study was 19.1 days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82-100%), for MRV reading, 99% (range, 96-100%) and for intermodality, 100% (range, 96-100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94-98%) and transverse sinuses (82-86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques. CONCLUSION Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease.
Collapse
Affiliation(s)
- Elka Miller
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Abstract
OBJECTIVE In the first part of this article, modern cranial sonography techniques and interpretation were discussed, emphasizing ways in which the application of modern imaging technology and techniques are able to enhance detection of pathologic abnormalities on cranial sonography. CONCLUSION In this part of the article, we will describe pitfalls and variants that may be confused with pathologic abnormalities. Emphasis will be placed on recognizing normal variations and distinguishing them from pathologic abnormalities that may require additional imaging or clinical follow-up.
Collapse
|