Dreidimensionaler Ultraschall (3DUS) des neonatalen Gehirns: klinische Anwendbarkeit bei intensivgepflegten Neugeborenen

Abstract

To prospectively evaluate the potential role of 3DUS of the neonatal brain. 60 patients from the NICU (gestational age: 25-42 weeks, mean: 31.6 weeks, age: 0 to 90 days, median: 10 days) underwent 2D- and 3D-neurosonography. Both studies were evaluated independently by two observers for comparison. Inter- and intraobserver variability were calculated. All 3DUS were of diagnostic quality and could be performed without sedation. 3DUS missed no essential diagnosis as established by conventional ultrasound (2DUS). Diagnosis included normal or physiologically immature neonatal brains (n = 21), plexus cysts (n = 4), plexus bleedings (n = 10), intraventricular haemorrhages grade I-III (n = 8), periventricular pathology such as periventricular echodensities (n = 4) and periventricular haemorrhages or cerebral infarctions (n = 6), hydrocephalus (n = 4), widened subdural spaces (n = 2) and one suprasellar midline tumour. 3DUS imaging time at the patient (4.8 +/- 2.6 min) was significantly shorter than for 2DUS (9.1 +/- 6.1 min). The additional axial plane provided by 3DUS improved the sonographic potential for differential diagnosis. 3DUS allowed an improved standardisation and documentation potentially valuable for follow-up. No statistically significant differences in intra- and interobserver variability were noted compared to 2DUS. Restrictions of 3DUS were the lack of directional Doppler data and the lower resolution particularly of the purely reconstructed plane. Bedside neonatal 3D-neurosonography at the NICU is feasible with diagnostic quality without sedation. 3DUS improves comparison during follow-up, as well as standardisation and documentation, and can be considered a useful adjunct in neonatal 2D-neurosonography.