2. head ultrasound in neonate 2013 [compatibility mode]

3/1/2013

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Indonesian Pediatric Society

Neonatology Working Group

Cardiology Working Group

Pediatric Imaging Working Group

Head ultrasound and

Echocardiography in Neonate

Head Ultrasound in NeonateII. Normal 2D Head Ultrasound

Evita Karianni Bermanshah Ifran

Pediatric Imagig Working Group


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Head ultrasound and


Head Ultrasound in Neonate

• Head ultrasound uses reflected sound waves to produce pictures of the brain and the inner fluid chambers (ventricles) through which cerebrospinal fluid (CSF) flowsfluid chambers (ventricles) through which cerebrospinal fluid (CSF) flows

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Head ultrasound and


Head US • Routine investigation during neonatal intensive care

• To assist in diagnosis

• To aid decision making in possible withdrawal of intensive carecare

• To monitor complications and interventions

• To identify acute cerebral events in newborns, especially white matter damage as the single strongest predictor of cerebral palsy

• To assist prognosis of motor and cognitive dysfunctions

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Head ultrasound and


Indications Head Ultrasound

(AIUM)

• In preterm, Term Neonate, and Infant: • To screen for haemorrhage or parenchymal abnormalities in

preterm infant

• To evaluate for haemorrhage• To evaluate for haemorrhage

• To evaluate for hydrocephalus

• To evaluate for presence of vascular abnormalities

• To evaluate for possible or suspected HIE

• To evaluate for the presence of congenital malformations

• For follow up or surveillance of previously documented abnormalities, including prenatal abnormalities

• For screening before surgical procedure

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Head ultrasound and


Probe• High frequency transducer with

small footprint (match the size of

fontanel)

– Sector scanner (3,5-5 Mhz)– Sector scanner (3,5-5 Mhz)

– Micro convex ((5-8 Mhz)

• High frequency (7-10 Mhz) linier

probe

– Extra cranial abnormality (e.g.

Hematoma, edema, cyst),

superior sagittal sinus.

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Head ultrasound and


Probe

Microconvex Sector Linier

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Head ultrasound and


Quality assurance

Should be checked annually for:

• electrical safety• electrical safety

• adequate resolution

• gray scale setting

• Brightness

• contrast

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Head ultrasound and


Competency

• Should have achieved an acceptable level of

competence before performing and reporting

scan independently.scan independently.

• Require technical competence.

• Training to recognise the appearance of the

common ultrasound pathological findings in

preterm and term babies.

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Head ultrasound and


To prevent cross

infections and damage

• Removal jewellery (e.g. ring, watch).

• Hand washing as standard procedure • Hand washing as standard procedure before and after scanning.

• Probe should be wiped and cleaned between each patients with an alcohol based wipe or use probe condoms to cover the probe.

• Store the probe securely in the special holder of ultrasound machine.

�

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Head ultrasound and


Baby safety

• Look to the baby monitor regularly during

scanning

• Stop if the baby develops complications • Stop if the baby develops complications

• Pressure on fontanel too hard may cause

bradycardia

• Scan the baby through the window of

incubator to prevent hypothermia

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Head ultrasound and


ID and orientation

• Name, age, and medical record number

should be recorded in each image

• Coronal images should be viewed with the • Coronal images should be viewed with the

right side of the baby on the left hand side of

the operator on screen

• Sagittal images with the nose of the baby on

the left hand side of the operator on screen

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Head ultrasound and


Notch or mark

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Head ultrasound and


Scan techniques

• Coronal

• Sagittal/parasagittal

• Supplemented: Axial, • Supplemented: Axial, posterior/lateral fontanel, sub-occipital

• Depth

• Gain

• Focus

• Symmetrical

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Head ultrasound and


Anterior Fontanelle: Coronal

Windows

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Head ultrasound and


Anterior Fontanelle: Coronal

Anterior Fontanelle: Sagittal

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Head ultrasound and


Posterior Fontanelle

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Head ultrasound and



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Head ultrasound and



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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Mastoid Fontanelle

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Head ultrasound and


Standard Images • Coronal

• Anterior to frontal horns of the lateral ventricles

• At the anterior horns of the lateral ventricles

• At the third ventricle• At the third ventricle

• At posterior hors of lateral ventricles with plexus choroids

• Posterior to plexus choroids

• Sagittal

• Midline through 3rd ventricle

• Through each lateral ventricle showing caudo-thalamic junction

• Through each hemisphere lateral to the ventricles

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Head ultrasound and


Coronal scan

1. Anterior to frontal horns of the lateral ventricles

2. At the anterior horns of the 2. At the anterior horns of the lateral ventricles

3. At the third ventricle4. At posterior hors of lateral

ventricles with plexus choroids

5. Posterior to plexus choroids

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Head ultrasound and


Sagittal scan

1. Midline through 3rd ventricle

2. Through each lateral 2. Through each lateral ventricle showing caudo-thalamic junction

3. Through each hemisphere lateral to the ventricles

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Head ultrasound and


supplement

• Additional views

o Posterior fontanel view

Mastoid fontanel viewoMastoid fontanel view

o Foramen magnum

o Any open suture

o Colour flow and Doppler may give additional data

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Head ultrasound and


Additional Windows

Posterior fontanelle

• Occipital horn, choroid plexus, basal cistern

• Detect intraventricular hemorrhage

• Distinguish normal peritrigonal blush• Distinguish normal peritrigonal blush

• Better delineation of posterior fossa

Temporal window

• Axial image of the ventricles

• Posterior fossa hemorrhage

Mastoid fontanelle

• Midbrain, basal cistern, posterior fossa

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Head ultrasound and


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Head ultrasound and


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Head ultrasound and


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Head ultrasound and


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Head ultrasound and


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Head ultrasound and


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Head ultrasound and


Parasagital

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Head ultrasound and


Parasagital

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Head ultrasound and


Suprasellar Cistern

Temporal lobe

Cerebral aquduct Intern peduncular fossa

Cerebral peduncle

TectumQuadrigeminal cistern

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Head ultrasound and


2. head ultrasound in neonate 2013 [compatibility mode]

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