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3D Ultrasound of the Neonatal Brain: Technique and Potential Value
INTRODUCTION
Conventional two-dimensional ultrasound (2DUS) is an established tool for imaging the brain in neonates and infants. As a bedside imaging modality it is ideal to evaluate severely sick neonates and infants. Most important conditions can reliably be identified significantly impacting further clinical management and prognosis, e.g., cerebral haemorrhage, cystic lesions, hydrocephalus, congenital brain malformations, brain tumors and asphyxia. Color-, power- and duplex Doppler sonography have further broadened applications in paediatric neurosonography enabling evaluation of cerebral vascular anatomy and perfusion. Transtemporal 2DUS (amplitude coded) and color Doppler sonography (aCDS) improves evaluation of the posterior fossa, and allows for visualization of cerebral vasculature and perfusion patterns even in older children.
There are several limitations of 2DUS: it is relatively operator dependent, standardisation is difficult, the neonatally preferred transfontanellar approach restricts the fi eld of view; and sometimes critical sections such as an axial plane is not available. All this impacts comparison of investigations during follow-up, comparison of 2DUS to CT and MRI, may obscure subtle changes in slowly evolving disease, and degrades diagnostic confi dence in some conditions.
Applications of 3DUS in clinical practice are expanding, also promoted by the increasing commercial availability of 3DUS equipment. In clinical and research settings 3DUS has been shown to be beneficial in evaluating the fetus. Applications in gynecology have become important (e.g., classification of uterine anomalies, estimation of endometrial volume, assessment of uterine fibroids and polyps, as well as evaluation of ovarian cysts and adnexal masses. In addition there are potential applications in cardiovascular imaging, oncology, neurology and neurosurgery, urology, interventional radiology and ophtalmonology. In pediatric radiology 3DUS is not used very often, but reports exist on some clinically useful pediatric applications. One of the most commonly reported pediatric 3DUS applications is in the neonatal brain, with similar merits as fetal neuro-3DUS; this will be the focus of this review.
Author:
Dr. Michael RICCABONA
Prof. of Paediatrics and Radiology
Department of Radiology, Division of Paediatric Radiology
University Hospital LKH Graz,
Auenbruggenplatz, A - 8036 Graz, Austria
Tel.: ++43 316 385 84205
Fax: ++43 316 385 4299
Email: michael.riccabona@meduni-graz.at