Abstracts

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E2216. Neurosonography
Authors
  1. Preet Sandhu; Le Bonheur Children's Hospital/University of Tennessee Health Science Center
  2. Vijetha Maller; Le Bonheur Children's Hospital/University of Tennessee Health Science Center
  3. Hiral Banker; Le Bonheur Children's Hospital/University of Tennessee Health Science Center
  4. Garret Lim; Le Bonheur Children's Hospital/University of Tennessee Health Science Center
  5. Harris Cohen; Le Bonheur Children's Hospital/University of Tennessee Health Science Center
Background
Ultrasound (US) plays a key role in imaging of neonatal brain and is often the first-line imaging modality. Anterior fontanelle provides an excellent imaging window. In addition, lack of radiation and portability further make the use of US even more important in sick neonates and young children in neonatal and pediatric intensive care units who cannot be transported for computerized tomography (CT) and magnetic resonance imaging (MRI) and sometimes require multiple follow-up examinations.

Educational Goals / Teaching Points
Discuss normal anatomy of neonatal brain on ultrasound with use of anterior fontanelle and trans mastoid views as imaging windows. Illustrate normal variants and congenital malformations of brain including agenesis of corpus callosum, holoprosencepahly and schizencephaly among others. Discuss and illustrate common pathologies such as germinal matrix hemorrhage, post-hemorrhagic hydrocephalus, periventricular leucomalacia and hypoxic ischemic injury in preterm neonates. Discuss hypoxic ischemic injury in term neonates, neonatal stroke, benign enlargement of subarachnoid spaces of infancy, subdural collections and perinatal infections. Discuss screening neurosonography in patients on extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Standard neonatal US examination includes coronal and sagittal imaging through anterior fontanelle, using curved linear array, sector or vector transducer. High frequency linear transducer can also be used to better delineate superficial structures. Meticulous technique to delineate the superficial structures such as extra-axial fluid, major sulci and fissures, and dural venous sinuses and deeper structures of the brain such as basal ganglia, thalami and corpus callosum is very important. Similarly, evaluation of the posterior fossa on all images with additional imaging using trans-mastoid approach should also be obtained.

Conclusion
Familiarity with proper US technique, normal US appearance of neonatal brain and imaging appearance of common and uncommon pathologies is of paramount importance for radiologists to make the correct diagnosis.