Usefulness of 3D sonography of the central nervous system in neonates and infants in the assessment of intracranial bleeding and its consequences when examined through the anterior fontanelle.

Abstract

Due to the possibility to examine at the patient bedside or incubator, ultrasound imaging of the central nervous system, particularly through the anterior fontanelle, is the most common diagnostic examination performed in neonates and infants with neurological problems. Despite its common application, this method has certain limitations. These limitations are associated with cross-sections of the cerebral structures that can be obtained when examining through the anterior fontanelle. The aim of the paper was to assess the usefulness of three dimensional sonography of the central nervous system in neonates and infants in the assessment of intracranial bleeding and its consequences when examined through the anterior fontanelle. The study enrolled 283 patients treated at the Pediatric Teaching Hospital at the Medical University of Lublin in whom a transfontanelle cerebral examination was indicated. The two- and three-dimensional ultrasound examinations of the central nervous system were conducted in 283 patients aged from 1 day to 18 months (mean age: 2 months). 254 three-dimensional examinations were of diagnostic value. The number of detected pathological lesions was higher in a statistically significant way (p = 0.007) in the three-dimensional ultrasound examination. In the authors’ own studies, the highest sensitivity and statistically significant superiority of the three-dimensional method over the two-dimensional one referred to detecting intraventricular or intracerebral hemorrhages. Novel techniques of ultrasound imaging, including the three-dimensional one, have undoubtedly increased the diagnostic possibilities of sonography and, at the same time, retained all its advantages.