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Ultrasonography of brain

Ultrasonography of brain in small breed dogs: how to do, what to see and main applications in veterinary medicine

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Ultrasonography of brain

  1. 1. Ultrasonography of brain Cibele Figueira Carvalho DMV, MSc, PhD Imaging Diagnostic Department - PROVET Researcher INRAD - HCFMUSP
  2. 2. Introduction • Alternative method • Low cost, non-invasive and safe • No anesthesia or contrasts • Allows repeated measurements and monitoring • Small breed dogs (<10kg): good image resolution
  3. 3. Technique Technique •Patient •Equipment •Acoustic windows •Planes of images
  4. 4. Equipment Technique •Patient •Equipment •Acoustic windows •Planes of images Real time equipment with: •linear probes (5 - 10MHz) -neonates and/ or opened rostral fontanelle •high resolution microconvex probes (2 - 6MHz) - adults (small breed dogs) with closed fontanelle
  5. 5. Acoustic windows Technique •Patient •Equipment •Acoustic windows •Planes of images • opened fontanelle (neonates, toy breeds until 3months of age or abnormal) • closed rostral fontanelle (small dogs, thin frontal bone) • Temporal (above zygomatic arch) • Suboccipital CARVALHO, 2004
  6. 6. • Saggital • Transversal • Dorsal Planes of images Technique •Patient •Equipment •Acoustic windows •Planes of images
  7. 7. ROSTRAL WINDOW Transversal Planes CARVALHO, 2014 Saggital Planes Technique •Patient •Equipment •Acoustic windows •Planes of images
  8. 8. Dorsal Planes CARVALHO, 2014 TEMPORAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images
  9. 9. SUBOCCIPITAL WINDOW Technique •Patient •Equipment •Acoustic windows •Planes of images Transversal and Saggital
  10. 10. Anatomy
  11. 11. Anatomy What can we see? • Sulci • Interhemispheric fissure • ventricular system (LV, III, IV, mesencephalic aqueduct) • Cerebellum • Brainstem • Medulla
  12. 12. • Sulci • fissure • Ventricular system • Cerebellum • Brainstem • Medulla Carvalho, 2014 Anatomy
  13. 13. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem • Medulla 2 4 1 3 2 Cr Ca 4 3 LE 1 D Carvalho et al. 2014 Anatomy
  14. 14. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla Cintra, Carvalho et al. 2014
  15. 15. 5 7 1 4 3 6 8 2 Cr Ca 7 5 1 4 6 3 2 8 LD V 1- temporal bone 2- temporal lobe 3- presilvian sulci 4- Tentoriun of cerebellum 5- Cerebellum 6- longitudinal fissure 7- Mesencephalon 8- etmoid bone • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla
  16. 16. • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla 2 4 1 3 5 2 1 1 6 3 4 Cintra, Carvalho et al. 2014
  17. 17. 1 5 6 3 4 Ca LE LD Cr 1 2 3 4 1- subaracnoid space 2- Medulla 3- Canal 4- Atlas 5- dorsal horn 6- ventral horn • Sulci • Fissure • Ventricular System • Cerebellum • Brainstem Anatomy • Medulla
  18. 18. Vascular anatomy • RI brain arteries = 0,55±0,04 (SEO et al.,2005) • RI basilar artery = 0,5 - 0,78 (SAITO et al.,2003)  Arterious circle  Vertebrobasilar system
  19. 19.  Arterious circle  Vertebrobasilar system Vascular anatomy
  20. 20.  Arterious circle  Vertebrobasilar system Vascular anatomy
  21. 21. Vertebrobasilar system  Arterious circle  Vertebrobasilar system
  22. 22.  Arterious circle  Vertebrobasilar system
  23. 23.  Arterious circle  Vertebrobasilar system
  24. 24. Transcranial Ultrasonography of congenital and adquired diseases
  25. 25. Transcranial Ultrasonography of congenital and adquired diseases • Hydrocephaly • Lissencephaly • Cyst (s) • Chiari-like lesions • Dandy walker • Trauma • Neoplasia • Encephalitis Carvalho et al. 2007
  26. 26. Hydrocephalus • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007; Carvalho et al. 2010
  27. 27. Lissencephaly • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker
  28. 28. Cysts quadrigeminal and aracnoid • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
  29. 29. Chiari-like • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
  30. 30. Dandy-walker Sindrome • Hydrocephaly • Lissencephaly • Cyst • Chiari-like • Dandy walker Carvalho et al. 2007
  31. 31. Trauma  Trauma  Neoplasias  NME  GME Carvalho et al. 2007
  32. 32. Neoplasias  Trauma  Neoplasias  NME  GME Carvalho et al. 2007
  33. 33. Encephalitis  Trauma  Neoplasias  NME  GME Carvalho, Perez et al. 2012
  34. 34. Encephalitis  Trauma  Neoplasias  NME  GME Carvalho, Perez et al. 2012
  35. 35. Physiology – main considerations • Supply of O2 • Glucose supply • Blood flow supply
  36. 36. Hemodynamic changing diseases Intracranial pressure (ICP) can be increased: •Hydrocephaly •Neoplasia •Encephalitis •Traumas •Neurodegeneration •Strokes
  37. 37. Hydrocephaly • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Sonographic images may demonstrate ventriculomegaly but the parameters obtained in B-mode are not suitable for monitoring the treatment and clinical evolution of the disease (Spaulding and Sharp, 1990; Tucker and Gavin, 1996)  Researches show that induced acute hydrocephaly in cats leads to a reduction of 22% in the blood flow of the brain, cerebellum, and encephalic trunk (Hochwald et al., 1975).
  38. 38. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  39. 39. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2010
  40. 40. Neoplasias • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Tumoral vessels are not always detected • Hemodynamic changes may occur because “mass effect” (stenosis), neoangiogenesis or trombosis • Intracranial pressure arising leads to elevated RI
  41. 41. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  42. 42. Encephalitis • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes • Granulomatous meningoencephalitis (GME) - hemodynamic changes are variable and progressive with the disease Carvalho et al., 2012
  43. 43. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  44. 44. Color Doppler image demonstrated conspicuous vessels in the arterial circle that appeared tortuous and more obvious than usual with minimum adjustments on color gain settings • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  45. 45. - Some ventriculomegaly degrees - Focal hyperechoic lesion (granuloma) - the diffuse brain congestion and inflammation can lead to a compensatory vasodilatation • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  46. 46. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes - Doppler spectral mapping can demonstrate low or high resistive index depending on mechanical compression (e.g., stenosis or occlusion) caused by the perivascular cuffs observed in pathologic evaluation, or space-occupying mass
  47. 47. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Granulomatous meningoencephalitis in a dog – increased blood vessels caliber; inflammatory process with mononuclear cells around subpial surface and ocluded blood vessels (hematoxilin eosin stain; scale 100 μm). Photo: Paulo C. Maiorka.
  48. 48. GME after treatment – histopathologic Degenerated areas; Partial lumen desobstruction; Increased vessels caliber • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  49. 49. Trauma • Focal lesion detection varies with location, extension and collateral damages; • Vessels change can be present or not • Focal lesion can cause “mass effect” and intracranial pressure (ICP) increase • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  50. 50. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes ICP x RI •RI is correlated to intracranial pressure (ICP) in patients with severe brain damage and in hydrocephalic infants; •and detecting brain death (after head injury) Rainov, 2000; Fukushima et al., 2000
  51. 51. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Neurodegeneration process displays some common morphological characteristics: •cortical cerebral atrophy, •ventricles enlargement, •diffuse deposits of β-amyloid (A) peptides, •senile plaques formation, •lipofuscin and intraneuronal “aging pigment” accumulations changing the cytoskeleton, •vascular changes in the cerebrum.
  52. 52. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration Neurodegeneration • Strokes Carvalho, 2009; Carvalho, 2012
  53. 53. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Brain strokes or cerebrovascular accidents • Stroke is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic and hemorrhagic stroke (Braund, 1994).
  54. 54. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  55. 55. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
  56. 56. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
  57. 57. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
  58. 58. • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho et al., 2012
  59. 59. Risk factors: Hyperlipemia Diabetes mellitus hypothyroidism hyperadrenocorticism Arterial Hypertension (might) Cardiac insufficiency Severe hypotension Hemorragic conditions Chronic lung diseases (hypoxia) Congenital condition Ex: Beagle’s vasculitis, cat’s idiopatic ischemic disease, Schnauzer’s hyperlipemia • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes
  60. 60. Brain stroke • Hydrocephaly • Neoplasia • Encephalitis • Traumas • Neurodegeneration • Strokes Carvalho, 2012
  61. 61. In conclusion... - Useful tool that can trial small breed dogs with neurologic signs
  62. 62. References CARVALHO CF, ANDRADE NETO JP. Encéfalo In: Ultrassonografia em pequenos animais. 2ed. Editora Roca, São Paulo. 2014. CARVALHO CF, ANDRADE NETO JP, JIMENEZ CD, DINIZ SA, CHAMMAS MC. Ultrassonografia transcraniana em cães com distúrbios de origem central. Arq. Bras. Med. Vet. Zootec., v.59, n.6, p.1412-1416, 2007. CARVALHO CF, CINTRA TCF, ANDRADE NETO JP. Ultrassonografia Doppler transcraniana. In: Carvalho, CF Ultrassonografia Doppler em pequenos animais. Editora Roca, 2009. CARVALHO CF, PEREZ RB, CHAMMAS MC, MAIORKA PC. Transcranial Doppler sonographic findings in granulomatous meningoencephalitis in small breed dogs. Canadian Veterinary Journal v.53, p.855–859, 2012. CARVALHO CF, ANDRADE NETO JP, DINIZ SA. Small breed dogs with confirmed stroke: concurrent diseases and sonographic findings. Arq. Bras. Med. Vet. Zootec., v.64, n.5, p.1177-1183, 2012. CINTRA TCF, CARVALHO CF, CANOLA JC, NEPOMUCENO AC. Ultrassonografia transcraniana em cães hígidos: padronização da técnica e descrição anatômica. Arq. Bras. Med. Vet. Zootec., v.66, n.1, p.61-68, 2014.
  63. 63. BERG, D.; GODAU, J.; WALTER, U. Transcranial sonography in movement disorders. Lancet Neurology. v.7, p.1044-1055, 2008. HUDSON, J. A. et al. Ultrasonographic anatomy of the canine brain. Veterinary Radiology, v. 30, n. 1, p. 13-21, 1989. HUDSON, J. A.; SIMPSON, S. T.; COX, N. R. Ultrasonographic examination of the normal canine neonatal brain. Veterinary Radiology, v. 32, p. 50-59, 1991. SAITO, M.; OLBY, J. N.; SPAULDING, K. Identification of arachnoid cysts in the quadrigeminal cistern using ultrasonography. Veterinary Radiology & Ultrasound, v. 42, n.5, p.435-439, 2001. GAROSI, L. S. Cerebrovascular disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, v. 40, p. 65-79, 2010. HILLOCK, S. M. et al. Vascular encephalopathies in dogs: incidence, risk factors, pathophysiology, and clinical signs. Compendium on Continuing Education for the Practicing Veterinarian, v. 2, n. 3, p. 196-207, 2006. LILLEHEI, K. O.; CHANDLER, W. F.; KNAKE, J. E. Real time ultrasound characteristics of the acute intracerebral hemorrhage as studied in the canine model. Neurosurgery, v.14, n.1, p. 48-51, 1984.
  64. 64. PLATT, S. R.; GAROSI, L. Canine cerebrovascular disease: Do dogs have strokes? Journal of the American Animal Hospital Association, v. 39, n. 4, p. 337-342, 2003. DE LAHUNTA, A.; GLASS, E. Veterinary neuroanatomy and clinical neurology. 3rd ed. Philadelphia: Saunders, 2009. HOSKINS, J. D.; SHELTON, G. D. The nervous and neuromuscular systems. In: HOSKINS, J. D. Veterinary pediatrics. 3rd. ed. Philadelphia: W.B. Saunders Co., 2001. Cap. 19, p. 425. FUKUSHIMA, U. et al. Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension. Journal Veterinary Medical Science, v. 62, n. 3, p. 353-355, 2000. SPAULDING, K. A.; NICHOLAS, J. H.; SHARP, B. Ultrasonographic imaging of the lateral cerebral ventricles in the dog. Veterinary Radiology, v. 31, n. 2, p. 59-64, 1990. BRAUND, K. G. Neurological syndromes. In: __ Clinical neurology in small animals: localization, diagnosis and treatment. New York: International Veterinary Information Service, 2003. SAITO, M. et al. Magnetic resonance imaging features of lissencephaly in 2 lhasa apsos. Veterinary Radiology & Ultrasound, v. 43, n. 4, p. 331-337, 2002.
  65. 65. Doubts???? Thank you for your attention! cibelefcarvalho@gmail.com
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Ultrasonography of brain in small breed dogs: how to do, what to see and main applications in veterinary medicine

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