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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Pediatric uterus, ovary, and testis
286
Testis
PREPARATION
None.
POSITION
Supine, with scrotal support as required.
TRANSDUCER
7.0–13.0 MHz linear transducer.
METHOD
Compare reectivity between the two sides on a single image. Obtain
transverse and longitudinal images.
APPEARANCE
The testes are homogenous and of medium-level reectivity.
MEASUREMENTS
Testis volume measurement is calculated using the following formula:
Length × Width × Height × 0.71
The mean volume of neonatal testis is 0.35 ml. The mean testicular volume increases in the rst 5 months from 0.27 to 0.44 ml, after which
the volume decreases to 0.31 ml at 9 months, remaining stable to 6
years.
The prepubescent volume is 1–2 ml, and at puberty the volume is
> 4ml.
Testicular volume greater than 2 ml allows reliable appreciation of
intratesticular color Doppler ow.
There is a ×2.5 increase in testicular length and width, and ×2 increase
in testicular depth between 10 and 17 years.
From the 10
1.36 ml to 12.83 ml in 17
th
year of life, the testicular volume increases ×10 from
th
year of life.
Testis
Testis volume is calculated by measuring the length (between cursors), width, and height.
287
The width and height (between cursors) measurements are obtained by turning the
transducer into the transverse plane.
FURTHER READING
Kuijper EAM, van Kooten J, Verbeke JIML, van Rooijen M,
Lambalk CB. Ultrasonographically measured testicular volumes
in 0- to 6-year-old boys. Hum Reprod. 2008; 23:792–796.
Osemlak P. Size of testes and epididymes in boys up to 17 years of
life assessed by ultrasound method and method of external linear
measurements. Med Wieku Rozwoj. 2011; 15:39–55.
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13
NEONATAL BRAIN
Annamaria Deganello and
PaulS.Sidhu
Neonatal brain (ventricular size) 290
Neonatal brain (Doppler ultrasound) 294
Neonatal brain
290
Neonatal brain (ventricular size)
PREPARATION
None.
POSITION
Supine.
TRANSDUCER
5.0–8.0 MHz curvilinear array transducer with a small footprint. A 10
MHz linear transducer will demonstrate the supercial subdural space
and superior sagittal sinus.
METHOD
Performed through the anterior fontanelle in the neonate where this
remains patent. The posterior fontanelle allows access to the posterior brain structures. Oblique coronal and oblique sagittal views are
obtained, and the frontal horns of the lateral ventricles are measured.
APPEARANCE
The ventricles are clearly identied as echo-free areas within the midlevel echoes of the brain parenchyma. The walls of the ventricles are
well demonstrated in the premature infant but are often opposed in the
term infant. Measurements are taken in the coronal direction at the
level of the foramen of Monro. A minor degree of asymmetry of the
ventricles is common, the left slightly larger. Serial measurements are
important to document progression or regression.
MEASUREMENTS
Ventricular width: Taken from the medial wall to the oor of the ven-
tricle at the widest point, measured at 0 mm when the ventricle appears
as a thin high-reective line; this should be described as depth rather
than width.
Neonatal brain (ventricular size)
Measurements are taken in the coronal direction at the level of the foramen of Monro.
Ventricular width measurement is taken from the medial wall to the oor of the ventricle at
the widest point.
291
Gestational age (weeks) Mean width (mm)
26–27 0.90
28–29 1.01
30–31 1.32
32–33 1.05
34–35 0.82
36–37 0.74
38–39 1.02
40–41 0.91
42 1.09
Adapted from Perry et al., 1985.
Neonatal brain
292
Ventricular ratio (VR): Using a transverse approach, from the temporal window (or lateral fontalle); the ventricular width (VW), from the
midline to the lateral ventricle wall; and the hemispheric width (HW),
from the midline to the inner skull margin, measurements were applied
to calculate the VR. (VR = VW/HW).
Term
neonates mean
Premature neonates
mean (range)
(range)
Lateral ventricle width
(VW)
Hemisphere width (HW) 3.9 cm
Ventricular-hemisphere
ratio (VW/HW)
Adapted from Johnson et al., 1979.
1.1 cm
(0.9–1.3 cm)
(3.1–4.7 cm)
28 cm
(24–30 cm)
1.0 cm
(0.5–1.3 cm)
3.1 cm
(2.1–4.3 cm)
31 cm
(24–34 cm)
The upper limit of normal for ventricular width measured in the sagittal plane is 1.3 cm for a single ventricle and 2.5 cm for both measured
together.
FURTHER READING
Brouwer MJ, deVries LS, Pistorius L, Rademaker KJ, Groenendaal
F, Benders MJ. Ultrasound measurements of the lateral ventricles
in neonates: Why, how and when? A systematic review. Acta
Paediatr. 2010; 99:1298–1306.
Johnson ML, Mack LA, Rumack CM, Frost M, Rashbaum C.
B-mode echoencephalography in the normal and high-risk
infant. AJR Am J Roentgenol. 1979; 133:375–381.
Perry RN, Bowman ED, Murton LJ, Roy RN, de Crespigny LC.
Ventricular size in newborn infants. J Ultrasound Med. 1985;
4:475–477.
Poland RL, Slovis TL, Shankaran S. Normal values for ventricular
size as determined by real time sonographic techniques. Pediat
Radiol. 1985; 15:12–14.
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Neonatal brain
294
Neonatal brain (Doppler ultrasound)
PREPARATION
None.
POSITION
1. Through the anterior fontanelle. Sagittal and angled/
sagittal or coronal and angled/coronal views.
2. Through the temporal bone. Axial image with transducer
placed 1 cm anterior and superior to tragus of the ear.
TRANSDUCER
Linear 7.5 MHz transducer.
METHOD
Resistance Index (RI) is obtained from middle cerebral (MCA), anterior
cerebral (ACA), internal carotid (ICA), and posterior cerebral arteries.
APPEARANCE
The ACAs and ICAs course parallel to the image plane on transfontanellar views, providing the optimum Doppler angle. For the same
reason, the MCAs are best visualized on the transtemporal view.
MEASUREMENTS
RI
Anterior cerebral (premature) 0.5–1.0
Anterior, middle, and posterior cerebral (term) 0.6–0.8
Internal carotid (term) 0.5–0.8
Intracranial RI normally decreases with increasing gestational age.
Gestational
age
(weeks)
24–28 14 ± 4 0.75 ± 0.07 20 ± 6 0.76 ± 0.07
29–32 17 ± 5 0.78 ± 0.06 26 ± 7 0.80 ± 0.07
33–37 19 ± 4 0.78 ± 0.07 29 ± 9 0.82 ± 0.07
38–41 24 ± 6 0.80 ± 0.07 31 ± 8 0.81 ± 0.08
ACA PSV
(cm/s)
ACA
RI
MCA PSV
(cm/s)
MCA
RI
A coronal image through the
anterior fontanell with a spectral
Doppler waveform obtained from
the middle cerebral artery from
which the resistive index (RI) may
be calculated.
Neonatal brain (Doppler ultrasound)
295
Birth weight
(g)
ACA PSV
(cm/s)
ACA
RI
MCA PSV
(cm/s)
MCA
RI
<1000 14 ± 4 0.76 ± 0.07 19 ± 6 0.77 ± 0.07
1001–1500 17 ± 4 0.78 ± 0.06 26 ± 6 0.82 ± 0.08
1501–2000 19 ± 5 0.78 ± 0.07 26 ± 8 0.80 ± 0.06
2001–2500 18 ± 4 0.76 ± 0.07 29 ± 9 0.80 ± 0.08
>2500 23 ± 6 0.80 ± 0.06 33 ± 8 0.83 ± 0.08
Adapted from Horgan et al., 1989.
Elevated or rising RI is seen in hydrocephalus and cerebral edema due
to hypoxic-ischemic brain injury. Low RI is seen in babies on extracorporeal membrane oxygenation.
FURTHER READING
Horgan JG, Rumack CM, Hay T, Manco-Johnson ML, Merenstein
GB, Esola C. Absolute intracranial blood-ow velocities
evaluated by duplex Doppler sonography in asymptomatic
preterm and term neonates. AJR Am J Roentgeneol.
1989;152:1059–1064.
Pezzati M, Dani C, Biadaioli R, Filippi L, Biagiotti R, Giani T,
Rubaltelli FF. Early postnatal Doppler assessment of cerebral
blood ow velocity in healthy preterm and term infants. Dev
Med Child Neurol. 2002; 44:745–752.
Raju TN, Zikos E. Regional cerebral blood velocity in infants. A
real-time transcranial and fontanellar pulsed Doppler study. J
Ultrasound Med. 1987; 6:497–507.