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新生兒顱腦(lúnǎo)超聲影像汪元芳

MD,ARDMS,ARVT第一頁(yè),共四十六頁(yè)。新生兒顱腦超聲Neurosonography1Technique,Indication,AnatomyProtocolIVH&PVLSpinalSonography第二頁(yè),共四十六頁(yè)。新生兒顱腦超聲TechniqueandIndication

Routinelyforprematureinfantsat6daysand4weeksandasneededtoruleoutIntraventricularHemorrhageandPeriventricularLeukomalacia,aswellasotherabnormalitiesTypicallyupto9monthsoraslongasfontanelleisopenUseanteriorfontanellemostly,alsotransmastoidandposteriorforbettervisualizationoftheposteriorfossaand4thventricleHighestfrequencytransducertoallowsufficientpenetrationandresolution(curvedorvector),linearimagestodefinesuperficialstructures第三頁(yè),共四十六頁(yè)。新生兒顱腦超聲AnatomyCorpusCollosumCSPCavumVergaeVelumInterpositumVentriclesChoroidPlexusCerebellumCaudateNucleusThalamusSylvianFissuresCircleofWillisCerebralHemispheresBrainCoveringLobesofCerebrum第四頁(yè),共四十六頁(yè)。新生兒顱腦超聲LobesofCerebrum

TemporalParietalFrontalOcciptal第五頁(yè),共四十六頁(yè)。新生兒顱腦超聲VentriclesLateralVentricle -FrontalHorn -Body -OccipitalHorn -TemporalHorn第六頁(yè),共四十六頁(yè)。新生兒顱腦超聲第七頁(yè),共四十六頁(yè)。新生兒顱腦超聲AnatomyCSFPathway-ChoroidPlexus-LateralVentricles-ForaminaofMonro-3rdVentricle-AqueductofSylvius-4thVentricle-ForaminaofMagendieandLuschka-ForamenMagnum第八頁(yè),共四十六頁(yè)。新生兒顱腦超聲Anatomy

CoveringofBrainSubduralVsSubarachnoidSubarachnoidSpaceSubduralSpace第九頁(yè),共四十六頁(yè)。新生兒顱腦超聲BESSI

(BenignEnlargementoftheSubarachnoid

SpacesofInfancy)

Enlargementoffrontal,temporalextracerebralCSFspaces,enlargementofthefrontalhorns,andmacrocephalyWillshowbridgingcorticalveins(todistinguishbetweensubduralcollectionswhichareneverbenign)SubarachnoidVsSubdural第十頁(yè),共四十六頁(yè)。新生兒顱腦超聲SubarachnoidVsSubdural第十一頁(yè),共四十六頁(yè)。新生兒顱腦超聲

ProtocolCoronalImages(frontaloccipital)FrontalatleveloforbitsOrbitalBonesFrontalhornsAnteriortoForamenofMonroMCARegion(MeasureLat.Vents.)ForamenofMonroPosterioraspectof3rdventriclethroughthalamiCerebellumandLateralVents.BodiesTentoriumLaertalVents.IncludingChoroidPlexusCortexofoccipitallobesandposteriorInterhemisphericFissure(periventricularwhitematter)第十二頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolCoronalMCARegionofCircleofWillisMCAMeasureLat.Vents3rdVentSylvianFissures第十三頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolCoronalThalami第十四頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolCoronalCerebellumTentoriumCerebellarVermis第十五頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolCoronalChoroidPlexusinLat.Vents.PeriventricularWhiteMatterInterhemisphericFissure(Falx)第十六頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittalMidlineincludingcorpuscallosum,cavum,3rdand4thvents,vermis,cisternamagnaCaudothalamicgrooveFrontalhornoflat.VentBodyoflat.VentincludingtemporalandoccipitalhornsSylvianfissueSulci/Gyrilateral第十七頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittal3rdVent.4thVent.CerebellarVermisAqueductofSylviusCorpusCollosumMidline第十八頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittalCavumVergaeCisternaMagnaVelumInterpositumCavumSeptumPellucidumMidline第十九頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittalThalamusCaudothalamicGrooveCaudateNucleus第二十頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittalTemperalHornofLat.VentSylvianFissureFrontalHornofLat.VentPeriventricularWhiteMatter第二十一頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolParasagittalPrematureSmoothBrainSulcationTerm第二十二頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolTransmastoidViewofcerebellum,4thventricle,foramenmagnumCerebellarhemisphereclosertotransducerwillhavebestresolution,thusweimagethecerebellumfromboththerightandleftmastoidfontanellesPosteriorfontanelleImagetheoccipitalhornsofthelateralventricles第二十三頁(yè),共四十六頁(yè)。新生兒顱腦超聲ProtocolPosteriorOccipitalHornofLat.Vent4thVent.CisternaMagnaTransmastoidCerebellum第二十四頁(yè),共四十六頁(yè)。新生兒顱腦超聲InterventricularHemorrhage

(IVH)Complicationsofprematurity:IVHandPVLGerminalmatrixconsistsofproliferatingcellsthatgiverisetoneuroblastswhichmigrateouttoformtheneuronsofthecerebralcortexandthebasalgangliaHighlyvascular,consistingofnetworkofthin-walledcapillaries,veinsandarteriolesEarlyingestation,germinalmatrixformssubependymalliningofentireventricularsystem.Maximizesinsizeat23-24wks,thenslowlyregresses,involuting3rdventandoccipitalandtemporalhornsfirstDuringendofgestation,onlysmallarearemainsovercaudatenucleus.By36weeks,almostcompletelygone.Germinalmatrixhemorrhageininfantsisusuallyvenousinorigin第二十五頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHRiskFactorsforIVH-prematureinfantInstabilityofCardiovascularsystemleadingtosuddenincreasesinbloodpressureAbsenceofautoregulatorymechanismwhichmaintainsconstantbloodflowtobrainMechanicsofventilation,trachealsuctioning,pnuemothorax,patentductusarteriosus,andhighinspiredoxygencontentbecausetheyallincreasesystemicpressureflowtobrain第二十六頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHClinicalFindingsDiminishedconsciousness,apnea,decreasedhematocrit,coma,seizures50%silent,detectedbyimaging80-90%ofIVHoccurswithinfirst4daysoflife第二十七頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGradeIHemorrhageCoronally,echogenicmassinferolateraltoflooroffrontalhornsandmedialtoheadofcaudatenucleusParasagitally,increasedechogenicityanteriortocaudothalamicgrooveUnilateralorbilateral,subependymal,normalventriclesizesResolvingclotundergoescentralliquefactionandmayformtinysubependymalcystGradeI第二十八頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGradeI第二十九頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGrade2HemorrhageIVH,hemorrhagerupturesthroughsubependymalliningintolat.VentsEchogenicmaterialfillspartorallofNON-dilatedventricularsystem,mayadheretochoroidandbedifficulttodistinguishDecreasesinsizeandechogenicityoverseveralweeksSubependymalliningofventsmaydevelopechogenicliningduetochemicalventriculitisGradeII第三十頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGradeII第三十一頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGrade3HemorrhageIVHwithventricularenlargementofoneorbothlat.VentsMayextendinto3rd,4thvents,andcavumUsuallyresolvesover5-6weeksMayresolvecompletelyorpersistasbandsorseptationsPost-hemorrhagichydrocephalusinmorethan2/3,usuallyremainsmild-mod,fewneedshuntplacement(<10%)GradeIII第三十二頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGradeIII第三十三頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGrade4HemorrhageIVHwithextensionintothebrainparenchymaadjacenttooneorbothlat.Vents,ventriculardilationCancausemasseffectwithmidlineshiftTypicallyfrontalorparietal,andunilateral(samesideasIVH)Ifbilateral,usuallyassymetric-helpingtodifferentiatefromnonhemorrhagicischemiclesions(PVL)whichtendtobebilaterl,symmetricalBy2-3months,areaofencephalomalaciadevelops,cancommunicatewithipsilaterallat.VentwhichisoftendilatedGradeIV第三十四頁(yè),共四十六頁(yè)。新生兒顱腦超聲IVHGradeIV第三十五頁(yè),共四十六頁(yè)。新生兒顱腦超聲PeriventricularLeukomalacia

(PVL)Inprematureinfant,sameriskfactorsasforIVH.Systemichypotensioncausesfallincerebralperfusion,leadingtoischemia,theninfarctionandultimatelyPVLPVLisanischemiclesionaffectingthedeepwhitematteradjacenttotrigonesoflat.ventsandfrontalhornsnearforamenofMonroClinically,hypotonia,seizures,apneicorbradycardiacepisodes.25-40%ofverylowbwinfants(<1000g)Increasedechogenicityofwhitematterseensonographically第三十六頁(yè),共四十六頁(yè)。新生兒顱腦超聲PVLSymmetricorassymetric2-3weeksafterischemicinsult,cysticchangesoccurcysticencephalomalaciaLargerareaofPVL,greatlikelihoodofhemorrhagicLargerareaofPVL,morelikelytohavecysticformationCerebralatrophylaterresultofPVLshowsasprominentinterhemisphericfissures,cerebralsulci,andlat.VentsSpasticdiplegiaofbothlegsisclassicneurologicsequelaofPVL.Inseverecases,mayaffectarms.Also,intellectualandvisualdeficitscanoccur.第三十七頁(yè),共四十六頁(yè)。新生兒顱腦超聲PVL第三十八頁(yè),共四十六頁(yè)。新生兒顱腦超聲SpinalSonographyMultipleimagesareobtainedoftheentirelengthofthespineinbothsagittalandtransversescanningplanesSpecialattentionpaidtoareaofquestion(dimple)toensurenoconne

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