新生儿颅脑超声PPT课件

新生儿颅脑超声影像,汪元芳MD,ARDMS,ARVT,1,.,Neurosonography1,Technique,Indication,AnatomyProtocolIVH&PVLSpinalSonography,2,.,TechniqueandIndication,Routinelyforprematureinfantsat6daysand4weeksandasneededtoruleoutIntraventricularHemorrhageandPeriventricularLeukomalacia,aswellasotherabnormalitiesTypicallyupto9monthsoraslongasfontanelleisopenUseanteriorfontanellemostly,alsotransmastoidandposteriorforbettervisualizationoftheposteriorfossaand4thventricleHighestfrequencytransducertoallowsufficientpenetrationandresolution(curvedorvector),linearimagestodefinesuperficialstructures,3,.,Anatomy,CorpusCollosumCSPCavumVergaeVelumInterpositumVentriclesChoroidPlexusCerebellumCaudateNucleusThalamusSylvianFissuresCircleofWillisCerebralHemispheresBrainCoveringLobesofCerebrum,4,.,LobesofCerebrum,TemporalParietalFrontalOcciptal,5,.,Ventricles,LateralVentricle-FrontalHorn-Body-OccipitalHorn-TemporalHorn,6,.,7,.,Anatomy,CSFPathway,-ChoroidPlexus-LateralVentricles-ForaminaofMonro-3rdVentricle-AqueductofSylvius-4thVentricle-ForaminaofMagendieandLuschka-ForamenMagnum,8,.,Anatomy,CoveringofBrain,SubduralVsSubarachnoid,SubarachnoidSpace,SubduralSpace,9,.,BESSI(BenignEnlargementoftheSubarachnoidSpacesofInfancy),Enlargementoffrontal,temporalextracerebralCSFspaces,enlargementofthefrontalhorns,andmacrocephalyWillshowbridgingcorticalveins(todistinguishbetweensubduralcollectionswhichareneverbenign),SubarachnoidVsSubdural,10,.,SubarachnoidVsSubdural,11,.,Protocol,CoronalImages(frontaloccipital)FrontalatleveloforbitsOrbitalBonesFrontalhornsAnteriortoForamenofMonroMCARegion(MeasureLat.Vents.)ForamenofMonroPosterioraspectof3rdventriclethroughthalamiCerebellumandLateralVents.BodiesTentoriumLaertalVents.IncludingChoroidPlexusCortexofoccipitallobesandposteriorInterhemisphericFissure(periventricularwhitematter),12,.,Protocol,Coronal,MCA,RegionofCircleofWillis,MCA,MeasureLat.Vents,3rdVent,SylvianFissures,13,.,Protocol,Coronal,Thalami,14,.,Protocol,Coronal,Cerebellum,Tentorium,CerebellarVermis,15,.,Protocol,Coronal,ChoroidPlexusinLat.Vents.,PeriventricularWhiteMatter,InterhemisphericFissure(Falx),16,.,Protocol,ParasagittalMidlineincludingcorpuscallosum,cavum,3rdand4thvents,vermis,cisternamagnaCaudothalamicgrooveFrontalhornoflat.VentBodyoflat.VentincludingtemporalandoccipitalhornsSylvianfissueSulci/Gyrilateral,17,.,Protocol,Parasagittal,3rdVent.,4thVent.,CerebellarVermis,AqueductofSylvius,CorpusCollosum,Midline,18,.,Protocol,Parasagittal,CavumVergae,CisternaMagna,VelumInterpositum,CavumSeptumPellucidum,Midline,19,.,Protocol,Parasagittal,Thalamus,CaudothalamicGroove,CaudateNucleus,20,.,Protocol,Parasagittal,TemperalHornofLat.Vent,SylvianFissure,FrontalHornofLat.Vent,PeriventricularWhiteMatter,21,.,Protocol,Parasagittal,PrematureSmoothBrain,Sulcation,Term,22,.,Protocol,TransmastoidViewofcerebellum,4thventricle,foramenmagnumCerebellarhemisphereclosertotransducerwillhavebestresolution,thusweimagethecerebellumfromboththerightandleftmastoidfontanellesPosteriorfontanelleImagetheoccipitalhornsofthelateralventricles,23,.,Protocol,Posterior,OccipitalHornofLat.Vent,4thVent.,CisternaMagna,Transmastoid,Cerebellum,24,.,InterventricularHemorrhage(IVH),Complicationsofprematurity:IVHandPVLGerminalmatrixconsistsofproliferatingcellsthatgiverisetoneuroblastswhichmigrateouttoformtheneuronsofthecerebralcortexandthebasalgangliaHighlyvascular,consistingofnetworkofthin-walledcapillaries,veinsandarteriolesEarlyingestation,germinalmatrixformssubependymalliningofentireventricularsystem.Maximizesinsizeat23-24wks,thenslowlyregresses,involuting3rdventandoccipitalandtemporalhornsfirstDuringendofgestation,onlysmallarearemainsovercaudatenucleus.By36weeks,almostcompletelygone.Germinalmatrixhemorrhageininfantsisusuallyvenousinorigin,25,.,IVH,RiskFactorsforIVH-prematureinfantInstabilityofCardiovascularsystemleadingtosuddenincreasesinbloodpressureAbsenceofautoregulatorymechanismwhichmaintainsconstantbloodflowtobrainMechanicsofventilation,trachealsuctioning,pnuemothorax,patentductusarteriosus,andhighinspiredoxygencontentbecausetheyallincreasesystemicpressureflowtobrain,26,.,IVH,ClinicalFindingsDiminishedconsciousness,apnea,decreasedhematocrit,coma,seizures50%silent,detectedbyimaging80-90%ofIVHoccurswithinfirst4daysoflife,27,.,IVH,GradeIHemorrhageCoronally,echogenicmassinferolateraltoflooroffrontalhornsandmedialtoheadofcaudatenucleusParasagitally,increasedechogenicityanteriortocaudothalamicgrooveUnilateralorbilateral,subependymal,normalventriclesizesResolvingclotundergoescentralliquefactionandmayformtinysubependymalcyst,GradeI,28,.,IVH,GradeI,29,.,IVH,Grade2HemorrhageIVH,hemorrhagerupturesthroughsubependymalliningintolat.VentsEchogenicmaterialfillspartorallofNON-dilatedventricularsystem,mayadheretochoroidandbedifficulttodistinguishDecreasesinsizeandechogenicityoverseveralweeksSubependymalliningofventsmaydevelopechogenicliningduetochemicalventriculitis,GradeII,30,.,IVH,GradeII,31,.,IVH,Grade3HemorrhageIVHwithventricularenlargementofoneorbothlat.VentsMayextendinto3rd,4thvents,andcavumUsuallyresolvesover5-6weeksMayresolvecompletelyorpersistasbandsorseptationsPost-hemorrhagichydrocephalusinmorethan2/3,usuallyremainsmild-mod,fewneedshuntplacement(10%),GradeIII,32,.,IVH,GradeIII,33,.,IVH,Grade4HemorrhageIVHwithextensionintothebrainparenchymaadjacenttooneorbothlat.Vents,ventriculardilationCancausemasseffectwithmidlineshiftTypicallyfrontalorparietal,andunilateral(samesideasIVH)Ifbilateral,usuallyassymetric-helpingtodifferentiatefromnonhemorrhagicischemiclesions(PVL)whichtendtobebilaterl,symmetricalBy2-3months,areaofencephalomalaciadevelops,cancommunicatewithipsilaterallat.Ventwhichisoftendilated,GradeIV,34,.,IVH,GradeIV,35,.,PeriventricularLeukomalacia(PVL),Inprematureinfant,sameriskfactorsasforIVH.Systemichypotensioncausesfallincerebralperfusion,leadingtoischemia,theninfarctionandultimatelyPVLPVLisanischemiclesionaffectingthedeepwhitematteradjacenttotrigonesoflat.ventsandfrontalhornsnearforamenofMonroClinically,hypotonia,seizures,apneicorbradycardiacepisodes.25-40%ofverylowbwinfants(1000g)Increasedechogenicityofwhitematterseensonographically,36,.,PVL,Symmetricorassymetric2-3weeksafterischemicinsult,cysticchangesoccurcysticencephalomalaciaLargerareaofPVL,greatlikelihoodofhemorrhagicLargerareaofPVL,morelikelytohavecysticformationCerebralatrophylaterresultofPVLshowsasprominentinterhemisphericfissures,cerebralsulci,andlat.VentsSpasticdiplegiaofbothlegsisclassicneurologicsequelaofPVL.Inseverecases,mayaffectarms.Also,intellectualandvisualdeficitscanoccur.,37,.,PVL,38,.,SpinalSonog