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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 18 Neonatal Brain Scanning Protocol 459
• Sylvian fissure
• Anatomy: Groove separating the frontal and temporal lobes of
the brain.
• Sonographic appearance: Resembles an echogenic “Y” turned on
its side. The middle cerebral artery can be seen pulsating here.
• Caudate nucleus
• Anatomy: Located within the concavity of the lateral angles of
each lateral ventricle.
• Sonographic appearance: Midgray with medium-level echoes.
• Germinal matrix/caudothalamic groove
• Anatomy: Vascular network located in the region of the caudate
nucleus and thalamus called the caudothalamic groove.
• Sonographic appearance: When visualized, it appears small and
echogenic. Note that this is the most common site for a subependymal hemorrhage.
• Quadrigeminal plate
• Anatomy: Posterior to the third ventricle.
• Sonographic appearance: Echogenic structure immediately superior
to the apex of the tentorium resembling the top of a pine tree.
Preparation
Patient Prep
• Keeping the baby warm is of utmost importance.
• The baby should be disturbed as little as possible, preferably left in
the isolette.
• If the baby is in a high-oxygen environment, this should be
maintained as much as possible, even though the baby must be
scanned there.
• Gowns and gloves are recommended.
• The portable ultrasound system should be wiped down with a
cleaning agent.
• Coupling gel should be at body temperature.
Transducer
• 7.5 MHz for premature infants less than 32 weeks’ gestation or less
than 1500 g.
• 5.0 to 3.0 MHz for term and older infants with open anterior
fontanelle.
Patient Position
• Supine with the head face up.
• Prone with the head lying on either side.
• It can be helpful to place a small cloth or towel under and/or beside
the baby’s head to help immobilize it during the scan.
460 PART V Small Parts Scanning Protocols
Coronal
Sagittal plane
Ax
Neonatal Brain Survey
NOTE: Use the anterior fontanelle (soft, unossified membrane-
covered space between the sutures of the skull) at the top of the head as
a window through which to angle or pivot the transducer. The diameter
of the fontanelle may restrict the amount of angulation and anatomy
seen. The posterior fontanelle may also be used.
NOTE: Use an ample amount of gel to help avoid too much transducer
pressure.
NOTE: While surveying the brain, close attention should be paid to all
intracranial anatomy and its symmetry.
Coronal plane
ial plane
Coronal Survey
Coronal Plane • Anterior Fontanelle Approach
CHAPTER 18 Neonatal Brain Scanning Protocol 461
1. Begin with the transducer perpendicular at the anterior fontanelle.
2. Slowly angle the transducer toward the face. Scan through the
frontal horns into the frontal lobes of the brain.
3. Slowly angle the transducer back to perpendicular.
4. Slowly angle the transducer posteriorly. Scan through the occipital
horns into the occipital lobes of the brain.
5. Slowly angle the transducer back to perpendicular.
Sagittal Survey
Sagittal Plane • Anterior Fontanelle Approach
1. Begin with the transducer perpendicular at the anterior fontanelle.
2. Slowly angle the transducer laterally toward the right lateral ven-
tricle. Scan through the temporal lobe of the brain to the level of
the Sylvian fissure.
3. Slowly angle the transducer back to perpendicular.
4. Repeat the first, second, and third steps, but angle the transducer
through the left hemisphere.
462 PART V Small Parts Scanning Protocols
Coronal
3
Neonatal Brain Required Images
Coronal Images
Coronal Plane • Anterior Fontanelle Approach
4
5
6
7
2
1
1. Coronal image of the FRONTAL LOBES of the brain with the interhemispheric fissure. Include the orbital cones and ethmoid sinus.
Interhemispheric
Right Left
Right frontal
fissure
lobe of
brain
Orbital cones
Ethmoid sinus
Left frontal
lobe of
brain
Labeled: CORONAL
CHAPTER 18 Neonatal Brain Scanning Protocol 463
Cavum septum
cerebral artery
2. Coronal image of the FRONTAL HORNS of the ventricles encompassing the caudate nucleus. Include the germinal matrix adjacent
to the ventricles and corpus callosum.
Corpus callosum
Caudate
nucleus
Right Left
Germinal matrix
Thalamus
Labeled: CORONAL
3. Coronal image of the FRONTAL HORNS and THALAMI. Include
the Sylvian fissures, septum pellucidum, third ventricle, and foramen
of Monro.
Interhemispheric
fissure
Lateral
ventricle
Right Left
Cavum septum
pellucidum
Frontal
horn
lateral
ventricle
Temporal
lobe
pellucidum
Caudate
nucleus
Third
ventricle
Temporal
lobe
Labeled: CORONAL
Foramen
of Monro
Sylvian
fissure
with middle
Thalamus
464 PART V Small Parts Scanning Protocols
Quadrigeminal
4. Coronal image of the bodies of the LATERAL VENTRICLES,
THALAMI, SYLVIAN FISSURES, CHOROIDAL FISSURES,
and TEMPORAL HORNS.
Cavum vergae
Caudate
nucleus body
Sylvian
fissure
Right Left
Thalamus
Choroidal
fissure
Cerebellar
hemisphere
Cerebral
peduncle
Pons
Body lateral
ventricle
Third
ventricle
Temporal
horn
lateral
ventricle
Tentorium
Labeled: CORONAL
5. Coronal image of the TENTORIUM CEREBELLI. Include the
Sylvian fissures and the cisterna magna.
plate
Temporal
horn
lateral
ventricle
Body lateral
ventricle
Thalamus
Right Left
Sylvian
fissure
Choroidal
fissure
Cisterna magna
Labeled: CORONAL
Tentorium
Cerebellum
CHAPTER 18 Neonatal Brain Scanning Protocol 465
6. Coronal image of the CHOROID PLEXUS in the atrium or trigone region.
Right Left
Choroid
plexus
Labeled: CORONAL
7. Coronal image of the OCCIPITAL LOBES of the brain.
Interhemispheric
fissure
Right Left
Right occipital
brain lobe
Lateral
ventricle
Labeled: CORONAL
466 PART V Small Parts Scanning Protocols
8
Sagittal
Third
Sagittal Images
Sagittal Plane • Anterior Fontanelle Approach
12
11
9
10
Midline Image
8. Sagittal midline image of the CAVUM SEPTUM PELLUCIDUM,
CORPUS CALLOSUM, THIRD VENTRICLE, FOURTH VENTRICLE, and CEREBELLUM, including the massa intermedia
(seen in two thirds of infants).
Cavum septum
pellucidum
Frontal
lobe
Corpus
callosum
Aqueduct of Sylvius
Fourth ventricle
Medulla
Midline
Labeled: SAG ML
NOTE: This image should be perpendicular at the midline.
ventricle
Massa
intermedia
Sulci
Occipital
lobe
Cerebellar
vermis
CHAPTER 18 Neonatal Brain Scanning Protocol 467
Right Hemisphere Images
9. Sagittal image of the RIGHT VENTRICLE, GERMINAL
MATRIX, CAUDATE NUCLEUS, THALAMUS, and CHOROID PLEXUS.
Germinal matrix
Anterior horn
lateral
ventricle
Caudate
nucleus
Temporal horn
lateral ventricle
Choroid plexus
Cerebellar vermis
Right lateral
Thalamus
Labeled: SAG RT LAT
NOTE: In some cases the frontal horn, body, temporal horn, and occipital horn cannot be imaged in the same plane. Therefore an additional
image(s) may be necessary.
10. Sagittal image of the RIGHT TEMPORAL LOBE of the brain at
the level of the Sylvian fissure.
Body lateral
ventricle
Trigone
Occipital
lobe
Occipital
horn
lateral ventricle
Sylvian
fissure
Labeled: SAG RT LAT
Right lateral
Temporal
lobe
468 PART V Small Parts Scanning Protocols
Germinal matrix
Left Hemisphere Images
11. Sagittal image of the LEFT VENTRICLE, GERMINAL MATRIX,
CAUDATE NUCLEUS, THALAMUS, and CHOROID PLEXUS.
Anterior horn
lateral
ventricle
Left lateral
Body lateral
ventricle
Trigone
Caudate
nucleus
Temporal horn
lateral ventricle
Choroid plexus
Cerebellar vermis
Thalamus
Occipital
lobe
Occipital
horn
lateral ventricle
Labeled: SAG LT LAT
NOTE: In some cases the frontal horn, body, temporal horn, and occipital horn cannot be imaged in the same plane. Therefore an additional
image(s) may be necessary.
12. Sagittal image of the LEFT TEMPORAL LOBE of the brain at
the level of the Sylvian fissure.
Left lateral
Sylvian
fissure
Temporal
lobe
Labeled: SAG LT LAT
NOTE: Alternative axial views through the temporal recess or posterior
fontanelle are options to further evaluate the lateral ventricular walls
and/or the occipital horns, respectively.