This document provides an overview of neonatal cranial and spine ultrasound. It describes the standard imaging planes and protocols for cranial ultrasound. Common neonatal intracranial pathologies are discussed such as germinal matrix hemorrhage, periventricular leukomalacia, and hypoxic ischemic injury. Grading of germinal matrix hemorrhages and cystic lesions are reviewed. Spine ultrasound technique, indications, and normal variants/pathologies including tethered cord and dermal sinus tracts are covered. Case examples of various conditions are also presented.
Drs. Escobar’s CMC X-Ray Mastery Project: November CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. They are joined by Marianne Dannemiller, PA who is an APP for Sanger Heat & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Aortic Aneursym
- Endovascular Aortic Repair (EVAR)
- EVAR Endoleak
- Right Sided Aortic Arch
- Tension Pneumothorax
- Thyroid Mass
glucagon secretion via the stimulation of pancreatic GLP‐1 receptors in beta and alpha cells and by increasing insulin sensitivity [5]. GLP-1 and its analogues can also amplify insulin signaling in brain cells, leading to increased insulin sensitivity in neurons [7, 8]. Within the cardiovascular system, GLP-1 receptors are expressed on endothelial cells, monocytes, macrophages, and vascular smooth muscle cells (VSMCs) [9]. GLP-1 receptors are also widely expressed in the central nervous system, including the brainstem, cerebellum, hippocampus, cortex, hypothalamus, and amygdala [7, 10, 11]. There, the cellular expression of GLP-1 receptors is predominantly confined to neurons and dendrites [11]. GLP-1RAs are overall well-tolerated, with their most common adverse effects being nausea, vomiting, and diarrhea [7]. It has been recently shown that there are cholecystokinin-expressing neurons in the caudal brainstem, which are activated postprandially and are responsive to GLP-1RAs, explaining in part the body weight-lowering effects of GLP-1RAs but also their ability to induce nausea [12]. Based on similarities in their amino acid sequence, GLP-1RAs are peptide derivatives of either exendin-4 (exenatide, lixisenatide, and efpeglenatide) or human GLP-1 (albiglutide, dulaglutide, liraglutide, and semaglutide). Moreover, based on their pharmacokinetic/pharmacodynamic profile, GLP-1RAs can be classified into short-acting (exenatide and lixisenatide) and long-acting (albiglutide, dulaglutide, exenatide extended-release, liraglutide, semaglutide, and efpeglenatide) [5, 6]. T he main pharmacokinetic difference between shortacting (half-life of 2–5 h) and long-acting (half-life > 12 h) GLP-1RAs is that short-acting GLP-1RAs are subject to wide fluctuations in the plasma concentration of the active compound, while long-acting GLP-1RAs exert a more constant effect on the GLP-1 receptor [13]. Furthermore, short-acting GLP-1RAs predominantly affect postprandial glucose levels, mainly by reducing
glucagon secretion via the stimulation of pancreatic GLP‐1 receptors in beta and alpha cells and by increasing insulin sensitivity [5]. GLP-1 and its analogues can also amplify insulin signaling in brain cells, leading to increased insulin sensitivity in neurons [7, 8]. Within the cardiovascular system, GLP-1 receptors are expressed on endothelial cells, monocytes, macrophages, and vascular smooth muscle cells (VSMCs) [9]. GLP-1 receptors are also widely expressed in the central nervous system, including the brainstem, cerebellum, hippocampus, cortex, hypothalamus, and amygdala [7, 10, 11]. There, the cellular expression of GLP-1 receptors is predominantly confined to neurons and dendrites [11]. GLP-1RAs are overall well-tolerated, with their most common adverse effects being nausea, vomiting, and diarrhea [7]. It has been recently shown that there are cholecystokinin-expressing neurons in the caudal brainstem, which are activated postprandially and are responsive to GLP
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August CasesSean M. Fox
Drs. Breeanna Lorenzen and Daniel Escobar are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Malignant Pleural Effusion
- Pericardial Effusion
- Traumatic Aortic Disruption
- Femoral Guidewire migration
- Disconnected HeRO graft
- Flail Chest
- Pulmonary Contusion
Blood supply of head & neck. Arterial & venous anastomosesEneutron
1. The coomon carotid artery
a) topography
- carotid sinus
- carotid body
2. Neurovascular bundles of the neck
3. The external carotid artery
4. The internal carotid artery
- arterial supply of the brain
5. Arterial anastomoses head and neck
6. Veins of the head and neck
Drs. Escobar’s CMC X-Ray Mastery Project: November CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. They are joined by Marianne Dannemiller, PA who is an APP for Sanger Heat & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Aortic Aneursym
- Endovascular Aortic Repair (EVAR)
- EVAR Endoleak
- Right Sided Aortic Arch
- Tension Pneumothorax
- Thyroid Mass
glucagon secretion via the stimulation of pancreatic GLP‐1 receptors in beta and alpha cells and by increasing insulin sensitivity [5]. GLP-1 and its analogues can also amplify insulin signaling in brain cells, leading to increased insulin sensitivity in neurons [7, 8]. Within the cardiovascular system, GLP-1 receptors are expressed on endothelial cells, monocytes, macrophages, and vascular smooth muscle cells (VSMCs) [9]. GLP-1 receptors are also widely expressed in the central nervous system, including the brainstem, cerebellum, hippocampus, cortex, hypothalamus, and amygdala [7, 10, 11]. There, the cellular expression of GLP-1 receptors is predominantly confined to neurons and dendrites [11]. GLP-1RAs are overall well-tolerated, with their most common adverse effects being nausea, vomiting, and diarrhea [7]. It has been recently shown that there are cholecystokinin-expressing neurons in the caudal brainstem, which are activated postprandially and are responsive to GLP-1RAs, explaining in part the body weight-lowering effects of GLP-1RAs but also their ability to induce nausea [12]. Based on similarities in their amino acid sequence, GLP-1RAs are peptide derivatives of either exendin-4 (exenatide, lixisenatide, and efpeglenatide) or human GLP-1 (albiglutide, dulaglutide, liraglutide, and semaglutide). Moreover, based on their pharmacokinetic/pharmacodynamic profile, GLP-1RAs can be classified into short-acting (exenatide and lixisenatide) and long-acting (albiglutide, dulaglutide, exenatide extended-release, liraglutide, semaglutide, and efpeglenatide) [5, 6]. T he main pharmacokinetic difference between shortacting (half-life of 2–5 h) and long-acting (half-life > 12 h) GLP-1RAs is that short-acting GLP-1RAs are subject to wide fluctuations in the plasma concentration of the active compound, while long-acting GLP-1RAs exert a more constant effect on the GLP-1 receptor [13]. Furthermore, short-acting GLP-1RAs predominantly affect postprandial glucose levels, mainly by reducing
glucagon secretion via the stimulation of pancreatic GLP‐1 receptors in beta and alpha cells and by increasing insulin sensitivity [5]. GLP-1 and its analogues can also amplify insulin signaling in brain cells, leading to increased insulin sensitivity in neurons [7, 8]. Within the cardiovascular system, GLP-1 receptors are expressed on endothelial cells, monocytes, macrophages, and vascular smooth muscle cells (VSMCs) [9]. GLP-1 receptors are also widely expressed in the central nervous system, including the brainstem, cerebellum, hippocampus, cortex, hypothalamus, and amygdala [7, 10, 11]. There, the cellular expression of GLP-1 receptors is predominantly confined to neurons and dendrites [11]. GLP-1RAs are overall well-tolerated, with their most common adverse effects being nausea, vomiting, and diarrhea [7]. It has been recently shown that there are cholecystokinin-expressing neurons in the caudal brainstem, which are activated postprandially and are responsive to GLP
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August CasesSean M. Fox
Drs. Breeanna Lorenzen and Daniel Escobar are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Malignant Pleural Effusion
- Pericardial Effusion
- Traumatic Aortic Disruption
- Femoral Guidewire migration
- Disconnected HeRO graft
- Flail Chest
- Pulmonary Contusion
Blood supply of head & neck. Arterial & venous anastomosesEneutron
1. The coomon carotid artery
a) topography
- carotid sinus
- carotid body
2. Neurovascular bundles of the neck
3. The external carotid artery
4. The internal carotid artery
- arterial supply of the brain
5. Arterial anastomoses head and neck
6. Veins of the head and neck
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
Slide 1: Title Slide
Extrachromosomal Inheritance
Slide 2: Introduction to Extrachromosomal Inheritance
Definition: Extrachromosomal inheritance refers to the transmission of genetic material that is not found within the nucleus.
Key Components: Involves genes located in mitochondria, chloroplasts, and plasmids.
Slide 3: Mitochondrial Inheritance
Mitochondria: Organelles responsible for energy production.
Mitochondrial DNA (mtDNA): Circular DNA molecule found in mitochondria.
Inheritance Pattern: Maternally inherited, meaning it is passed from mothers to all their offspring.
Diseases: Examples include Leber’s hereditary optic neuropathy (LHON) and mitochondrial myopathy.
Slide 4: Chloroplast Inheritance
Chloroplasts: Organelles responsible for photosynthesis in plants.
Chloroplast DNA (cpDNA): Circular DNA molecule found in chloroplasts.
Inheritance Pattern: Often maternally inherited in most plants, but can vary in some species.
Examples: Variegation in plants, where leaf color patterns are determined by chloroplast DNA.
Slide 5: Plasmid Inheritance
Plasmids: Small, circular DNA molecules found in bacteria and some eukaryotes.
Features: Can carry antibiotic resistance genes and can be transferred between cells through processes like conjugation.
Significance: Important in biotechnology for gene cloning and genetic engineering.
Slide 6: Mechanisms of Extrachromosomal Inheritance
Non-Mendelian Patterns: Do not follow Mendel’s laws of inheritance.
Cytoplasmic Segregation: During cell division, organelles like mitochondria and chloroplasts are randomly distributed to daughter cells.
Heteroplasmy: Presence of more than one type of organellar genome within a cell, leading to variation in expression.
Slide 7: Examples of Extrachromosomal Inheritance
Four O’clock Plant (Mirabilis jalapa): Shows variegated leaves due to different cpDNA in leaf cells.
Petite Mutants in Yeast: Result from mutations in mitochondrial DNA affecting respiration.
Slide 8: Importance of Extrachromosomal Inheritance
Evolution: Provides insight into the evolution of eukaryotic cells.
Medicine: Understanding mitochondrial inheritance helps in diagnosing and treating mitochondrial diseases.
Agriculture: Chloroplast inheritance can be used in plant breeding and genetic modification.
Slide 9: Recent Research and Advances
Gene Editing: Techniques like CRISPR-Cas9 are being used to edit mitochondrial and chloroplast DNA.
Therapies: Development of mitochondrial replacement therapy (MRT) for preventing mitochondrial diseases.
Slide 10: Conclusion
Summary: Extrachromosomal inheritance involves the transmission of genetic material outside the nucleus and plays a crucial role in genetics, medicine, and biotechnology.
Future Directions: Continued research and technological advancements hold promise for new treatments and applications.
Slide 11: Questions and Discussion
Invite Audience: Open the floor for any questions or further discussion on the topic.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
1. Neonatal Cranial and
Neonatal Cranial and
Spine Ultrasound
Spine Ultrasound
Ana Maria Gaca, MD
Ana Maria Gaca, MD
Pediatric Radiology
Pediatric Radiology
Duke University Medical Center
Duke University Medical Center
Durham, North Carolina
Durham, North Carolina
17. 17
17
Germinal Matrix
Germinal Matrix
„
„ Source of immature neural tissue
Source of immature neural tissue
–
– Largest at 23
Largest at 23-
-24 wks gestation
24 wks gestation
–
– Essentially involutes by 36 wks
Essentially involutes by 36 wks gestation
gestation
„
„ Most common site of intracranial
Most common site of intracranial
hemorrhage in the preterm infant
hemorrhage in the preterm infant
(20% of infants < 1500 g)
(20% of infants < 1500 g)
–
– 80
80-
-90% by 96 hours of life
90% by 96 hours of life
„
„ Venous
Venous hemorrhage
hemorrhage
18. 18
18
Intracranial Hemorrhage
Intracranial Hemorrhage
-
- Screening
Screening
„
„ Who?
Who?
–
– < 32 weeks gestation
< 32 weeks gestation
–
– Weight < 1500 g
Weight < 1500 g
„
„ When?
When?
–
– 4
4-
-7 days after birth
7 days after birth -
- 90% of
90% of
hemorrhages occur in first week of life
hemorrhages occur in first week of life
–
– Weekly to evaluate for hydrocephalus
Weekly to evaluate for hydrocephalus
19. 19
19
Intracranial Hemorrhage
Intracranial Hemorrhage
-
- Imaging
Imaging
„
„ Germinal matrix bleed
Germinal matrix bleed
–
– ovoid echogenic mass in the
ovoid echogenic mass in the
caudothalamic
caudothalamic groove
groove
„
„ Intraventricular hemorrhage
Intraventricular hemorrhage
–
– Lateral, 3
Lateral, 3rd
rd and 4
and 4th
th ventricles
ventricles
–
– May fill ventricle, layer dependently or
May fill ventricle, layer dependently or
adhere to
adhere to choroid
choroid
20. 20
20
Grading of Germinal
Grading of Germinal
Matrix Hemorrhage
Matrix Hemorrhage
„
„ I
I -
- Subependymal
Subependymal
„
„ II
II -
- Subependymal
Subependymal with blood in
with blood in
nondilated
nondilated ventricles
ventricles
„
„ III
III -
- Subependymal
Subependymal with blood in
with blood in
dilated ventricles
dilated ventricles
„
„ IV
IV -
- Subependymal
Subependymal, intraventricular
, intraventricular
and
and intraparenchymal
intraparenchymal*
*
*
* Formerly referred to as parenchymal extension
Formerly referred to as parenchymal extension
31. 31
31
Periventricular
Periventricular
Leukomalacia
Leukomalacia
„
„ 25
25-
-40% of very low birth wt babies
40% of very low birth wt babies
„
„ Focal necrosis of deep white matter
Focal necrosis of deep white matter
„
„ Watershed ischemic infarction
Watershed ischemic infarction
„
„ US sensitivity 28
US sensitivity 28 –
– 50%
50%
„
„ Early
Early –
– normal
normal →
→ increased
increased
echogenicity
echogenicity
„
„ Late
Late –
– cystic
cystic encephalomalacia
encephalomalacia (2
(2-
-6
6
wks)
wks)
34. 34
34
Hemorrhage in Term
Hemorrhage in Term
Infants
Infants
„
„ Rarely germinal matrix hemorrhages,
Rarely germinal matrix hemorrhages,
often venous bleeds
often venous bleeds
„
„ Site of hemorrhage
Site of hemorrhage
–
– Choroid
Choroid plexus
plexus
–
– Thalamus
Thalamus
–
– Subpial region
Subpial region
„
„ Infants often severely stressed
Infants often severely stressed
64. 64
64
Spine Ultrasound
Spine Ultrasound -
-
Technique
Technique
„
„ Screening exam
Screening exam
„
„ Sagittal and axial planes
Sagittal and axial planes
„
„ Linear transducer
Linear transducer
„
„ Patient imaged prone
Patient imaged prone
„
„ Can image from craniocervical junction
Can image from craniocervical junction
to sacrum
to sacrum
65. 65
65
Spine Ultrasound
Spine Ultrasound -
-
Indications
Indications
„
„ Multiple congenital anomalies
Multiple congenital anomalies
„
„ Complicated sacral dimple
Complicated sacral dimple
–
– Above the
Above the gluteal
gluteal crease
crease
–
– Bottom of pit not seen
Bottom of pit not seen
–
– Possible drainage from dimple
Possible drainage from dimple
–
– Skin stigmata (
Skin stigmata (hemangioma
hemangioma, cutis
, cutis
aplasia
aplasia, hairy patch and skin tags)
, hairy patch and skin tags)
„
„ Soft tissue mass suggesting
Soft tissue mass suggesting spina
spina
bifida
bifida occulta
occulta
66. 66
66
Spine Ultrasound
Spine Ultrasound
„
„ Conus medullaris
Conus medullaris
–
– Normally between L1 and L2
Normally between L1 and L2
–
– Should not be below L2
Should not be below L2-
-L3
L3
„
„ Filum terminale
Filum terminale
–
– Cordlike, echogenic structure
Cordlike, echogenic structure
–
– May be hard to differentiate from nerve
May be hard to differentiate from nerve
roots of cauda equina
roots of cauda equina
71. 71
71
Normal Variants
Normal Variants
Ventriculus
Ventriculus Terminalis
Terminalis
„
„ Ependyma
Ependyma lined
lined
„
„ Distal cord
Distal cord
„
„ DDx
DDx –
–
–
– Syrinx
Syrinx
–
– Transient dilation of
Transient dilation of
central canal
central canal
Reprinted with permission from the American
Journal of Roentgenology (AJR:188, March 2007)
72. 72
72
Normal Variants
Normal Variants
Transient dilation of
Transient dilation of
central canal
central canal
„
„ Healthy newborns
Healthy newborns
„
„ Usually disappears
Usually disappears
in first weeks of life
in first weeks of life
73. 73
73
Normal Variants
Normal Variants
Filar
Filar cyst
cyst
„
„ Within
Within filum
filum (vs.
(vs.
conus
conus medullaris
medullaris of
of
terminal ventricle)
terminal ventricle)
„
„ Midline
Midline
„
„ Just below
Just below conus
conus
„
„ Well defined
Well defined
„
„ Simple cyst
Simple cyst
75. 75
75
Tethered cord
Tethered cord
„
„ Incomplete/failed regression distal
Incomplete/failed regression distal
cord
cord
„
„ Low
Low conus
conus: below L2
: below L2-
-L3 disk space,
L3 disk space,
lack of normal nerve root motion
lack of normal nerve root motion
„
„ Tight
Tight filum
filum syndrome
syndrome –
– conus
conus at
at
normal level, but still tethered
normal level, but still tethered
–
– US
US -
- ↓
↓ or absent nerve root movement
or absent nerve root movement
82. 82
82
Dorsal Dermal Sinus
Dorsal Dermal Sinus
„
„ Tract: skin to canal
Tract: skin to canal
„
„ Dimple or ostium
Dimple or ostium
„
„ Midline or
Midline or
paramedian
paramedian
„
„ Complications
Complications –
–
meningitis, abscess
meningitis, abscess
83. 83
83
Pseudosinus
Pseudosinus Tract
Tract
„
„ Pilonidal
Pilonidal sinus
sinus
„
„ Hypoechoic
Hypoechoic tract
tract
from skin
from skin →
→ coccyx
coccyx
„
„ Check carefully for
Check carefully for
mass or fluid along
mass or fluid along
or originating from
or originating from
tract
tract