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新生儿颅脑超声影像汪元芳MD,ARDMS,ARVTNeurosonography1Technique,Indication,AnatomyProtocolIVH&PVLSpinalSonographyTechniqueandIndicationRoutinelyforprematureinfantsat6daysand4weeksandasneededtoruleoutIntraventricularHemorrhageandPeriventricularLeukomalacia,aswellasotherabnormalitiesTypicallyupto9monthsoraslongasfontanelleisopenUseanteriorfontanellemostly,alsotransmastoidandposteriorforbettervisualizationoftheposteriorfossaand4thventricleHighestfrequencytransducertoallowsufficientpenetrationandresolution(curvedorvector),linearimagestodefinesuperficialstructuresAnatomyCorpusCollosumCSPCavumVergaeVelumInterpositumVentriclesChoroidPlexusCerebellumCaudateNucleusThalamusSylvianFissuresCircleofWillisCerebralHemispheresBrainCoveringLobesofCerebrumLobesofCerebrumTemporalParietalFrontalOcciptalVentriclesLateralVentricle-FrontalHorn-Body-OccipitalHorn-TemporalHornAnatomyCSFPathway-ChoroidPlexus-LateralVentricles-ForaminaofMonro-3rdVentricle-AqueductofSylvius-4thVentricle-ForaminaofMagendieandLuschka-ForamenMagnumAnatomyCoveringofBrainSubduralVsSubarachnoidSubarachnoidSpaceSubduralSpaceBESSI(BenignEnlargementoftheSubarachnoidSpacesofInfancy)-Enlargementoffrontal,temporalextracerebralCSFspaces,enlargementofthefrontalhorns,andmacrocephaly-Willshowbridgingcorticalveins(todistinguishbetweensubduralcollectionswhichareneverbenign)SubarachnoidVsSubduralSubarachnoidVsSubduralProtocolCoronalImages(frontaloccipital)FrontalatleveloforbitsOrbitalBonesFrontalhornsAnteriortoForamenofMonroMCARegion(MeasureLat.Vents.)ForamenofMonroPosterioraspectof3rdventriclethroughthalamiCerebellumandLateralVents.BodiesTentoriumLaertalVents.IncludingChoroidPlexusCortexofoccipitallobesandposteriorInterhemisphericFissure(periventricularwhitematter)ProtocolCoronalMCARegionofCircleofWillisMCAMeasureLat.Vents3rdVentSylvianFissuresProtocolCoronalThalamiProtocolCoronalCerebellumTentoriumCerebellarVermisProtocolCoronalChoroidPlexusinLat.Vents.PeriventricularWhiteMatterInterhemisphericFissure(Falx)ProtocolParasagittalMidlineincludingcorpuscallosum,cavum,3rdand4thvents,vermis,cisternamagnaCaudothalamicgrooveFrontalhornoflat.VentBodyoflat.VentincludingtemporalandoccipitalhornsSylvianfissueSulci/GyrilateralProtocolParasagittal3rdVent.4thVent.CerebellarVermisAqueductofSylviusCorpusCollosumMidlineProtocolParasagittalCavumVergaeCisternaMagnaVelumInterpositumCavumSeptumPellucidumMidlineProtocolParasagittalThalamusCaudothalamicGrooveCaudateNucleusProtocolParasagittalTemperalHornofLat.VentSylvianFissureFrontalHornofLat.VentPeriventricularWhiteMatterProtocolParasagittalPrematureSmoothBrainSulcationTermProtocolTransmastoidViewofcerebellum,4thventricle,foramenmagnumCerebellarhemisphereclosertotransducerwillhavebestresolution,thusweimagethecerebellumfromboththerightandleftmastoidfontanellesPosteriorfontanelleImagetheoccipitalhornsofthelateralventriclesProtocolPosteriorOccipitalHornofLat.Vent4thVent.CisternaMagnaTransmastoidCerebellumInterventricularHemorrhage(IVH)Complicationsofprematurity:IVHandPVLGerminalmatrixconsistsofproliferatingcellsthatgiverisetoneuroblastswhichmigrateouttoformtheneuronsofthecerebralcortexandthebasalgangliaHighlyvascular,consistingofnetworkofthin-walledcapillaries,veinsandarteriolesEarlyingestation,germinalma...