Neonatal transcranial ultrasound

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This lecture prides 8 easy steps of scanning the neonatal brain through anterior fontanelle ,followed by examples of most commonly encountered abnormalities.

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Neonatal transcranial ultrasound

  1. 1. Neonatal transcranial ultrasound...The normal ,and abnormal . Dr/Ahmed Bahnassy Consultant Radiologist PSMMC
  2. 2. Technical considerations 1.choosing the probe. 2.adjusting depth and focus. 3.adjusting gain. 4.right and left labelling. 5.planes consideration. 6.use of previous scans for moving heads
  3. 3. Planes and landmarks coronal sagittal
  4. 4. Coronal scan 1
  5. 5. Coronal scan 2
  6. 6. Coronal scan 3
  7. 7. Coronal scan 4
  8. 8. Coronal 5
  9. 9. Importance of standardizing scans Brain diagram showing a coronal view as seen in ultrasound by greater fontanel. this explain some usefull measurements for ultrasound in neonatal brain: 1- Lateral ventricle (posterior horn): normal ≤ 13mm 2 - Third ventricle: normal ≤ 10mm 3 - Interhemispheric fissure: normal ≤ 6mm 4 - Subarachnoid space ≤ 4mm
  10. 10. Midline sagittal
  11. 11. Para-sagittal 1
  12. 12. Para-sagittal 2
  13. 13. Para-sagittal 3
  14. 14. Other imaging planes
  15. 15. Germinal matrix Highly vascular structure that gives rise to nerve cells. Just above the caudothalamic groove and beneath ependymal lining of ventricles. Begins to involute at 3rd month of gestation and complete by 36 week. Source of bleeding in premature infants.
  16. 16. Germinal matrix haemorhage(acute)
  17. 17. Resolving haemorhage
  18. 18. Grades II and III
  19. 19. Grade IV
  20. 20. Periventricular echogenicity According to van Wezel et al. • Grade 0: normal echogenicity of the periventricular white matter ( less than that of the choroid plexus) • Grade 1: moderately increased echogenicity of the periventricular white matter, the affected region being almost as bright or as bright as the choroid plexus . Grade 2: seriously increased echogenicity, the affected region being obviously brighter than the choroid plexus .... • Separate notation: homogeneous, nonhomogeneous .
  21. 21. Periventricular leukomalacia
  22. 22. Subarachnoid and subdural collections
  23. 23. Ischaemic injury • Hyperechogenic areas in thalamus .caudate nucleus...watershed areas. Low RI Compensatory mechanism.
  24. 24. Abnormal (cyst )!!
  25. 25. Using doppler
  26. 26. Posterior fossa abnormality Arnold Chiari malformation Dandy walker complex
  27. 27. Missing structure 1 normal
  28. 28. Missing structure 2 normal
  29. 29. Missing structure 3 normal
  30. 30. abnormal (canal )
  31. 31. abnormal echogenic shadows.
  32. 32. Structure too large
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