Neonatal transcranial ultrasound...The normal ,and

abnormal .

Dr/Ahmed BahnassyConsultant Radiologist

PSMMC

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

Planes and landmarks

coronal

sagittal

Coronal scan 1

Coronal scan 2

Coronal scan 3

Coronal scan 4

Coronal 5

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

Midline sagittal

Para-sagittal 1

Para-sagittal 2

Para-sagittal 3

Other imaging planes

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.

Germinal matrix haemorhage(acute)

Resolving haemorhage

Grades II and III

Grade IV

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, non-homogeneous .

Periventricular echogenicity

Periventricular leukomalacia

Subarachnoid and subdural collections

Ischaemic injury• Hyperechogenic areas in

thalamus .caudate nucleus...watershed areas.

Low RICompensatory mechanism.

Abnormal (cyst )!!

Using doppler

Posterior fossa abnormality

Arnold Chiari malformation Dandy walker complex

Missing structure 1

normal

Missing structure 2

normal

Missing structure 3

normal

abnormal (canal )

abnormal echogenic shadows.

Structure too large