Cranial Ultrasound Research Articles

A standardized approach to routine cranial ultrasonography in preterm infants: Improved neuromotor outcome predictability at 2 years and communication with parents

Aim: The aim of this study is to evaluate the predictive value of routine cranial ultrasonography in preterm infants under 32 weeks' gestation with their neuromotor outcome at 2 years. Methods: This was a prospective, single-center, cohort study of preterm infants under 32 weeks' gestation. Each infant had an early (within 1 week of birth) and late (at 6 weeks postnatal age) cranial ultrasound scan performed. Each infant's scan result was independently assessed for the presence of major cranial abnormalities, such as intraventricular hemorrhage Grade 3 or 4, cystic periventricular leukomalacia, and porencephalic cyst. All surviving infants who returned for follow-up at 2 years' corrected age had their neuromotor development assessed using the Bayley Scales of Infant Development. The predictive value of major cranial abnormalities for the neuromotor delay was derived. Results: A total of 134 infants were included over 2 year. Of the 89 children with no major abnormality, 78 did not have a significant neuromotor delay, giving a negative predictive value of 87.6%. Of the six children with major abnormalities, two had a significant neuromotor delay, giving a positive predictive value of 33.3%. Conclusions: The absence of a major abnormality on quality-controlled routine cranial ultrasound scan in preterm infants under 32 weeks' gestation appears to be a good predictor of no significant abnormality in neuromotor development at 2 years of age.

Incidence of periventricular leukomalacia in preterm very low birth neonates – A tertiary care experience

Background: The periventricular leukomalacia (PVL) is the most common white matter injury in preterm very low birth weight (VLBW) neonates. It occurs due to ischemic injury to developing oligodendrocytes. It can be detected by cranial ultrasonography (CUS). Objective: The objective of the study was to find incidence of PVL in preterm VLBW babies and its correlation with gestational age, birth weight, and arterial blood PH. Materials and Methods: A total of 80 preterm low birth babies admitted in our neonatal intensive care unit over 1 year were included who met the inclusion criteria. All babies were subjected to CUS starting from the 1st week of their life and repeated weekly by trained radiologist to find changes suggestive of PVL till clinically indicated or normal scan on the 14th day of life. Results: Among 80 preterm low birth babies in our study, 54 (67.5%) were male and 26 (32.5%) were female. Three babies had gestational age of 30 weeks or less, 25 had gestational between 30 and 32 weeks, 35 had gestational age between 32 and 34 weeks, while 17 had gestational age more than 34 weeks. A total of 62 (77.5%) were born through normal vaginal delivery and 18 (22.5%) were born by cesarean section. The incidence of PVL was 2.5%. The most common change was periventricular flare. The incidence of PVL was more in extreme preterm and those with PH <7.2. The mortality was 50% in babies with PVL. Conclusion: The incidence of PVL in preterm low birth weight babies is 2.5% with a mortality of 50%. Prevention and early detection are the keys to mitigate the effects of this disastrous complication of prematurity.

Impact of a web-based module on trainees\u2019 ability to interpret neonatal cranial ultrasound

BackgroundAccurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills.MethodsTrainees’ needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants’ satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project.ResultsRespondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees.ConclusionA WBL module for teaching neonatal CUS interpretation considerably improved trainees’ knowledge and enhanced their skills in interpreting neonatal CUS.

Use of Ultrasound in the Planning of Spring-Assisted Cranioplasty for Correction of Scaphocephaly

Craniosynostosis describes the congenital, premature fusion of 1 or more cranial sutures. Prior studies have confirmed the ability of spring-assisted cranioplasty to expand the cranial vault in patients with craniosynostosis. Historically, preoperative planning for spring-assisted cranioplasty was performed using mainly computed tomography (CT). In particular, osteotomies were planned and bone thickness was measured to determine the gauge of spring required. Despite the benefits for presurgical planning, CT scans have several drawbacks including ionizing radiation to a newborn and increased healthcare expense. The authors describe a clinical case of using solely cranial ultrasonography in the preoperative planning of spring-assisted cranioplasty for a patient with scaphocephaly. Ultrasonography can be used as alternative means of measuring parietal bone thickness and preoperative planning for spring-assisted cranioplasty, while also decreasing the risk of ionizing radiation and minimizing healthcare costs.

Application value of cranial ultrasonography in quantitative evaluation of neonatal intracranial hemorrhage.

Intracranial hemorrhage is a severe cranial disease in the perinatal period. We aimed to explore the feasibility and accuracy of three-dimensional (3D) ultrasonography for the quantitative evaluation of neonatal intracranial hemorrhage. A total of 374 neonates with suspected intracranial hemorrhage from January 2017 to December 2019 were selected to be primarily screened by cranial ultrasonography and then diagnosed by cranial CT scan. The examination results were compared to analyze the feasibility and accuracy of 3D ultrasonography in quantifying blood loss. CT scan showed that there were 102 cases of Papile grade I, 106 cases of grade II, 124 cases of grade III and 42 cases of grade IV. 3D ultrasonography showed that there were 108 cases of Papile grade I, 98 cases of grade II, 130 cases of grade III and 38 cases of grade IV. The diagnostic results of these two methods were not significantly different (P>0.05). The accuracies of CT scan for subventricular, intraventricular, subdural, subarachnoid and intraparenchymal hemorrhages were 47.33%, 31.24%, 94.62%, 91.73% and 91.35% respectively, and those of 3D ultrasonography were 98.74%, 96.37%, 91.51%, 90.41% and 97.64% respectively. The accuracies of 3D ultrasonography were significantly superior to those of CT scan for subependymal, intraventricular and intraparenchymal hemorrhages (P<0.05). Neonatal intracranial hemorrhage can be well diagnosed by cranial ultrasonography which timely provides evidence for clinicians, thereby elevating the cure rate and reducing the mortality rate and incidence rate of sequelae. 3D ultrasonography is feasible and accurate for the quantitative evaluation of neonatal intracranial hemorrhage, thus being of great significance to prognostic determination in clinical practice.

CRANIAL ULTRASOUND IN DETECTION OF NEUROLOGICAL LESIONS IN PRETERM NEONATES IN A TERTIARY CARE HOSPITAL – A PROSPECTIVE OBSERVATIONAL STUDY.

BACKGROUND: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these.Preterm neonates, defined as childbirth occurring at less than 37 completed weeks of gestation, is a major determinant of neonatal mortality and morbidity because of their greater risk for intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE). The morbidity associated with preterm birth often extends to later life, resulting in enormous physical, psychological and economic costs. Currently, many imaging modalities are available like Cranial Ultrasonography, Computed Tomography and Magnetic Resonance Imaging to detect the intracranial abnormalities in these neonates. However advantages of Cranial Ultrasonography are easy availability, not expensive, easy to perform, quick, can be done at bedside, repeatable and radiation free. The aims of the study were to identify the severity of brain injuries by grading the neurosonographic findings and to correlate the clinical presentations with the neurosonographic findings. MATERIALS AND METHODS: This study is done in Department of pediatrics in Neonatal Intensive Care Unit in Universal College of Medical Sciences ,a tertiary care hospital, Bhairahawa. This cross-sectional study comprise of 60 preterm neonates, referred to Department of Radio diagnosis for cranial ultrasonogram. Ultrasound examination of the neonatal brain done through anterior fontanelle in coronal and sagittal planes within 1st week using healthcare logiq p6 pro ultrasound machine. RESULTS: In this cross-sectional study of 60 neonates, 46 were male and 14 were female. Among 60 babies, 30 (50%) showed normal study and remaining 30 (50%) showed abnormal scan. Among the cases which were abnormal on scan most common finding was GMH (33.3%) and next commonest was periventricular leucomalacia (PVL- 16.7%) noted in 10 babies. CONCLUSION: Cranial ultrasonography is the best point of care neuroimaging method available for high-risk neonates. It is critical as an investigatory modality in NICU and effectively documents morphology of cerebral damage.

Assessment of Hypoxic Ischemic Changes in Perinatal Asphyxia of First Ultasonogram of Brain

Background: In in perinatal asphyxia, hypoxic ischemic brain injury remains most serious condition causing significant mortality and long term morbidity. Early detection of intracranial changes and its consequences will enhance timely intervention and better out come. Cranial sonography can be done to assess the abnormalities of brain in perinatal asphyxia. Objectives: The objective of this study was to evaluate usefulness of assessment of Hypoxic Ischemic Changes in perinatal asphyxia of first Ultasonogram of Brain. Methods: This was an observational study conducted from March 2018 to February 2019 at department of radiology and imaging, Dhaka Shishu Children Hospital, Dhaka, Bangladesh. Total 100 neonates with perinatal asphyxia were included in this study. Cranial USG was done in all cases and sonographic abnormalities were evaluated. Result: This study was 56 term (&gt;37 weeks of gestation) and 44 preterm (&lt;37 weeks of gestation) newborn having birth asphyxia were taken as cases in this study. Common cranial sonographic findings of preterm babies were periventricular leukomalacia 29% (13), germinal matrix hemorrhage 14% (6), Intraventricular hemorrhage 11% (5) cerebral oedema 7% (3) and normal 39% (17). Common cranial USG findings in term babies were cerebral oedema 43% (24), intracerebral hemorrhage 5% (3), Focal cerebral infarct 4% (2), Intraventricular hemorrhage 2% (1) and normal 46% (26). Conclusion: This study found that transcranial sonography is useful to identify the abnormalities in brain of asphyxiated neonate and helps to predict the neurodevelopmental outcome. So proper management plan can be done.

The effects of a postural supporting “New Nesting Device” on early neurobehavioral development of premature infants

BackgroundExtended positioning is believed to have negative impacts on the neurodevelopment of the infants. Currently, many neonatal intensive care unit (NICU) in China do not have adequate posture supporting device for premature infants. Positional support has been done often by using bed sheet, washcloth or blanket. Inadequate posture support can hinder the neurobehavioral development of premature infants. PurposeThe study aims to compare the effects of neurobehavioral development outcomes between a “New Nesting Device” and a “Traditional-Nest” posture supporting interventions, for premature infants from NICU admission to 36th week of gestational age after birth. MethodsThe study followed the Quasi-experimental study design. A total of 95 participants were randomized to either a “New Nesting Device” group (n = 49) or “Traditional-Nest” group (n = 46) after admission. All participating premature infants were assessed at 34th and 36th weeks of gestational age, and posture, body movements and early neurobehavioral outcomes were measured. Posture and body movements were recorded once at 34th weeks and again at 36th weeks. Digital video camera was used at the bedside to record an uninterrupted 12-h-long session to obtain posture and behavioral data. All participating premature infants received aEEG and cranial ultrasonography examinations at bedside to evaluate early neurobehavioral outcomes when they reached 34th weeks and again 36th weeks of gestational age. ResultsThe “New Nesting Device” group had better effects on posture (p＜0.001 for both), and demonstrated more smooth body movements (p = 0.018, p＜0.001) than premature infants of the “Traditional-Nest” group at both 34th and 36th weeks of gestational age. The “New Nesting Device” group also captured higher frequencies of “sleep-wake cycling” (p = 0.049, p = 0.037) through aEEG examination compared to the “Traditional-Nest” group at 34th and 36th weeks of gestational age. Conclusions“New Nesting Device” can provide premature infants a comfortable posture support similar to the flex posture they had while in the uterus. Smooth body movements and non-extended extremities can promote early neurobehavioral development. This study demonstrates the effects of the newly designed posture support device on premature infants. It also introduced the features of the newly designed nesting device for clinical nurse to understand how the nesting device can enhance comfort and support the neurobehavioral development of premature infants. Implications for practice and researchFurther research is needed to determine the cost and long-term effect contribution to the overall neurobehavioral development of premature infants by continued use of this soothing posture support device after discharge from NICU. The study also provides reference for the selection of posture supporting intervention and outcome measurements for future similar clinical studies.

Randomized Control Trial of Postnatal rhIGF-1/rhIGFBP-3 Replacement in Preterm Infants: Post-hoc Analysis of Its Effect on Brain Injury.

Background: Postnatal insulin-like growth factor-1 (IGF-1) replacement with recombinant human (rh)IGF-1 and IGF binding protein-3 (rhIGF-1/rhIGFBP-3) is being studied as a potential treatment to reduce comorbidities of prematurity. We have recently reported on a phase II, multicenter, randomized, controlled trial comparing postnatal rhIGF-1/rhIGFBP-3 replacement with standard of care (SOC) in extremely preterm infants (NCT01096784). Maximum severity of retinopathy of prematurity was the primary endpoint of the trial and presence of GMH-IVH/PHI one of the pre-specified secondary endpoints. Infants therefore received serial cranial ultrasound scans (CUS) between birth and term age. In this post-hoc analysis we present a detailed analysis of the CUS data of this trial and evaluate the effect of postnatal rhIGF-1/rhIGFBP-3 replacement on the incidence of different kinds of brain injury in extremely preterm infants.Methods: This report is an exploratory post-hoc analysis of a phase II trial in which infants <28 weeks gestational age were randomly allocated to rhIGF-1/rhIGFBP-3 or SOC. Serial cranial ultrasounds were performed between birth and term-equivalent age. Presence of germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH), periventricular hemorrhagic infarction (PHI), post-hemorrhagic ventricular dilatation, and white matter injury (WMI) were scored by two independent masked readers.Results: The analysis included 117 infants; 58 received rhIGF-1/rhIGFBP-3 and 59 received SOC. A trend toward less grade II–III GMH-IVH and PHI was observed in treated infants vs. SOC. A subanalysis of infants without evidence of GMH-IVH at study entry (n = 104) showed reduced progression to GMH-IVH in treated infants (25.0% [13/52] vs. 40.4% [21/52]; not significant). No effects of rhIGF-1/rhIGFBP-3 on WMI were observed.Conclusion: The potential protective effect of rhIGF-1/rhIGFBP-3 on the occurrence of GMH-IVH/PHI appeared most pronounced in infants with no evidence of GMH-IVH at treatment start.

Movement Disorder as Unusual Manifestation of Chiari Malformation Type II in a Newborn

AbstractChiari malformation type II (CM-II) is a hindbrain developmental malformation. Movement disorders are rarely described as associated with this condition. We describe the case of a newborn affected by CM-II presenting with head and neck tremors a few days after myelomeningocele repair surgery. Later, self-resolving episodes of expiratory apneas arose. Cranial ultrasounds showed progressive ventricular dilatation. She underwent ventriculoperitoneal shunt followed by craniocervical bony decompression. After surgery, both apnea and tremors disappeared. This particular presentation of CM-II is very rare and potentially difficult to diagnose.

Early maternal Zika infection predicts severe neonatal neurological damage: results from the prospective Natural History of Zika Virus Infection in Gestation cohort study.

To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV-infected Brazilian women and their infants. Prospective population-based cohort study. Ribeirão Preto's region's private and public health facilities. Symptomatic ZIKV-infected mothers and their infants. Prenatal/early neonatal data were obtained for all mother-child pairs. A subgroup of infants had cranial ultrasonography, eye fundoscopy, hearing and neurological examinations and Bayley III screening tests within 3 months of age. Prevalence of pregnancy losses and anomalies detected at birth or within 3months according to the gestational age of infection. Overall, 511 ZIKV-infected women were identified from a total of 1116 symptomatic women; as there were two twins, there were a total of 513 fetuses included. Of these, 13 (2.5%; 95% CI 1.5-4.3) presented with major signs of congenital Zika syndrome (CZS). Of the 511 women, there were 489 livebirths and 24 (4.7%) pregnancy losses (20 miscarriages and four stillbirths). ZIKV-related anomalies occurred in the offspring of 42/511 (8.2%) mothers. Microcephaly or other CNS malformations were diagnosed in 1/4 (25.0%) stillbirths and in 19/489 (3.9%; 95% CI 2.5-5.9) of the liveborn infants. Fetal abnormalities were 14.0 (95% CI 7.6-26.0) times more likely with gestational infection occurring in ≤11weeks. On follow up of 280 asymptomatic infants, 2/155 (1.3%) had eye abnormalities, 1/207 (0.5%) had CNS imaging findings and 16/199 (8%) presented neurological alert signs. This prospective population-based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong association between the gestational age of infection (≤11weeks) and a poorer early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within 3months of age. ZIKV and pregnancy: adverse outcomes are less common, more prevalent for first-trimester infections, and potentially subclinical.

Genetic predictors of severe intraventricular hemorrhage in extremely low-birthweight infants.

To test associations between grades 3 or 4 (severe) intraventricular hemorrhage (IVH) and single nucleotide polymorphisms (SNPs) associated with coagulation, inflammation, angiogenesis, and organ development in an exploratory study. Extremely low-birthweight (ELBW) infants enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's (NRN) Cytokines Study were included if they had cranial ultrasound (CUS) and genotyping data available in the NRN Anonymized DNA Repository and Database. Associations between SNPs and IVH severity were tested with multivariable logistic regression analysis. One hundred thirty-nine infants with severe IVH and 687 infants with grade 1 or 0 IVH were included. One thousand two hundred seventy-nine SNPs were genotyped. Thirteen were preliminarily associated with severe IVH including five related to central nervous system (CNS) neuronal and neurovascular development. Genetic variants for CNS neuronal and neurovascular development may be associated with severe IVH in premature infants.

Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging

Central nervous system (CNS) infections are potentially life threatening in neonates and can lead to the ill-defined diagnosis of ventriculitis. With this study we aimed to explore and describe ventriculitis regarding clinical, microbiological and ultrasonographic characteristics. We performed a retrospective cohort study including all neonates with a culture-proven CNS infection admitted to our tertiary NICU over a 12-year period (2004–2016). For each case clinical data was gathered, and three timed cranial ultrasounds were anonymized and retrospectively reviewed and assessed for signs of ventriculitis. Forty-five patients were included with 9 (20%) diagnosed with ventriculitis. Mortality in both ventriculitis and non-ventriculitis cases was one-third. Patients with pre-existing conditions as post-haemorrhagic hydrocephalus are at risk of developing ventriculitis. Most common pathogens were gram negative bacteria (68.9%). Ultrasonographic signs of ventriculitis developed over time, and interrater agreement was substantial.Conclusion: Neonatal ventriculitis is a serious entity in the continuum of meningitis. Early and correct diagnoses of ventriculitis are both important because of possible persisting or newly developing hydrocephalus or seizures. Sequential imaging should be performed.What is Known:• CNS infections in neonates lead to high mortality and morbidity.• Ventriculitis is a severe complication of meningitis.What is New:• High morbidity; the majority of ventriculitis patients have pre-existing PHVD and develop seizures and hydrocephalus.• Interrater agreement is good; bedside CUS is a useful tool for reaching a sustainable diagnosis of ventriculitis.

A low incidence of preoperative neurosonographic abnormalities in neonates with heart defects

Background and aimTo investigate whether neonates with prenatally detected congenital heart defects (CHD) demonstrate cerebral abnormalities on early preoperative cranial ultrasound (CUS), compared to healthy neonates, and to measure brain structures to assess brain growth and development in both groups. Study design, subjects and outcome measuresProspective cohort study with controls. Between September 2013 and May 2016 consecutive cases of prenatally detected severe isolated CHD were included. Neonatal CUS was performed shortly after birth, before surgery and in a healthy control group. Blinded images were reviewed for brain abnormalities and various measurements of intracranial structures were compared. ResultsCUS was performed in 59 healthy controls and 50 CHD cases. Physiological CUS variants were present in 54% of controls and in 52% of CHD cases. Abnormalities requiring additional monitoring (both significant and minor) were identified in four controls (7%) and five CHD neonates (10%). Significant abnormalities were only identified in four CHD neonates (8%) and never in controls. A separate analysis of an additional 8 CHD neonates after endovascular intervention demonstrated arterial stroke in two cases that underwent balloon atrioseptostomy (BAS). Cerebral measurements were smaller in CHD neonates, except for the cerebrospinal fluid measurements, which were similar to the controls. ConclusionsThe prevalence of significant preoperative CUS abnormalities in CHD cases was lower than previously reported, which may be partially caused by a guarding effect of a prenatal diagnosis. Arterial stroke occurred only in cases after BAS. As expected, neonates with CHD display slightly smaller head size and cerebral growth.

Progress in the Application of Ultrasound Elastography for Brain Diseases.

Ultrasound (US) can be used to evaluate the brain structure and nervous system damage. Patients with neurologic symptoms need rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging is currently the most sensitive and specific imaging method for evaluating neuropathologic conditions. This approach does present some challenges, such as the need to transport patients who may be seriously ill to the magnetic resonance imaging suite and the need for patients to remain for a considerable time. Cranial US provides a very valuable imaging method for clinicians, which can make a rapid diagnosis and evaluation without ionizing radiation. The main disadvantage of cranial US is its low sensitivity and specificity for subtle/early lesions. In recent years, with the rapid development of anatomic and functional US technology, the practicability of US diagnosis and intervention has been greatly improved. Ultrasound elastography may have the potential to improve the sensitivity and specificity of various cranial nerve conditions. Ultrasound elastography has received considerable critical attention, and an increasing number of studies have recognized its critical role in evaluating brain diseases. At present, US elastography has been applied to the evaluation of traumatic brain injury, ischemic stroke, intraoperative brain tumors, and hypoxic ischemic encephalopathy. The latest animal experiments and human clinical trial developments in the applications of US elastography for brain diseases are summarized in this review.

Autologous transplantation of umbilical cord blood-derived cells in extreme preterm infants: protocol for a safety and feasibility study

IntroductionPreterm brain injury continues to be an important complication of preterm birth, especially in extremely premature infants. Umbilical cord blood-derived cells (UCBCs) are increasingly being evaluated for their neuroprotective and...

Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units.

To identify patterns of neuroimaging (NI), including cranial ultrasounds (CUS) and magnetic resonance imaging (MRI), among a large cohort of United States NICU infants. The retrospective cohort study of the Pediatrix Clinical Data Warehouse for infants discharged between 2008 and 2017. From the 863,863 infants during the study period, 204,197 (24%) had at least one NI study. CUS was the most common study (n = 189,190, 22%) followed by MRI (n = 37,107, 4%). From 2008 to 2017, the percentage of infants who underwent any NI decreased from 28 to 21% (p < 0.001) driven primarily by a reduction in CUS. MRI use for infants ≤33 weeks increased through 2015 and then decreased. Overall reductions in NI have been driven by decreased use of CUS in infants born at 31-33 weeks' gestational age. MRI use among preterm infants has been more dynamic with an initial rise and recent decrease.

Accuracy of cranial ultrasound in the diagnosis of hydrocephalus in children under 6 months of age keeping CT scan as a gold standard

Background: CT and MRI modalities are considered a gold standard for the diagnosis of hydrocephalus. The more readily available and cheap options like sonography are being sought out for the diagnosis of this entity. Objectives: To determine the accuracy of cranial ultrasonography in the diagnosis of hydrocephalus keeping CT scan as a gold standard. Study design: Cross-sectional study Place and duration of study: Department of Pediatrics, Combined Military Hospital, Rawalpindi, from 01-01-2017 to 30-06-2017 Materials and Methods: A total of 121 children with a clinical diagnosis of hydrocephalus were selected and subjected to ultrasound of the head. Subsequently, a CT scan of the head was done and both modalities were compared. The diagnostic accuracy of the ultrasound was determined to keep CT findings as to the gold standard. Results: The mean age was 51.36 ± 34.01 days. The male gender was dominant as 81 (66.9%) patients were males. Ultrasonography of the head detected 93 (76.9%) patients with hydrocephalus while CT scan detected 90 (74.4%). Sensitivity, specificity, PPV, NPV and accuracy of USG to diagnosed hydrocephalus were 88.9%, 58.1%, 86.0%, 64.3% and 80.99% respectively Conclusion: Ultrasonography of head is a valuable screening tool for the diagnosis of hydrocephalus. Keywords: Hydrocephalus, Tomography, X-Ray Computed, Ultrasonography

Ultrasound-Based Phenotyping of Lateral Ventricles to Predict Hydrocephalus Outcome in Premature Neonates.

Prediction of post-hemorrhagic hydrocephalus (PHH) outcome-i.e., whether it requires intervention or not-in premature neonates using cranial ultrasound (CUS) images is challenging. In this paper, we present a novel fully-automatic method to perform phenotyping of the brain lateral ventricles and predict PHH outcome from CUS. Our method consists of two parts: ventricle quantification followed by prediction of PHH outcome. First, cranial bounding box and brain interhemispheric fissure are detected to determine the anatomical position of ventricles and correct the cranium rotation. Then, lateral ventricles are extracted using a new deep learning-based method by incorporating the convolutional neural network into a probabilistic atlas-based weighted loss function and an image-specific adaption. PHH outcome is predicted using a support vector machine classifier trained using ventricular morphological phenotypes and clinical information. Experiments demonstrated that our method achieves accurate ventricle segmentation results with an average Dice similarity coefficient of 0.86, as well as very good PHH outcome prediction with accuracy of 0.91. Automatic CUS-based ventricular phenotyping in premature newborns could objectively and accurately predict the progression to severe PHH. Early prediction of severe PHH development in premature newborns could potentially advance criteria for diagnosis and offer an opportunity for early interventions to improve outcome.

Isolated agenesis of the corpus callosum and normal general intelligence development during postnatal life: a case report and review of the literature

BackgroundAgenesis of the corpus callosum can occur isolated or as part of a complex congenital syndrome. Patients with isolated agenesis of the corpus callosum may present with severe intellectual disability, although a proportion of affected individuals develop normal intelligence. However, even in patients with no apparent deficits, subtle neuropsychological alterations may occur as the cognitive demand increases with age. Hence, patients with this deffect require a strict follow-up during their postnatal life. Thus, physicians require a better knowledge of the cognitive features of agenesis of the corpus callosum to improve their approach to this cerebral malformation. Here, we report an illustrative case of a school-age child with isolated agenesis of the corpus callosum and normal intelligence. We also provide a literature review about the postnatal screening of neurocognitive deficits in patients with agenesis of the corpus callosum.Case presentationAn 8-year-old Hispanic boy with total agenesis of the corpus callosum attended for medical follow-up. The defect was identified during the neonatal period by cranial ultrasonography and brain computed tomography scan. However, he did not present any craniofacial or non-cerebral malformation suggestive of a congenital syndrome. Furthermore, he showed no neuropsychiatric disorder or intellectual disability during his early childhood. At the age of 4, he was subjected to a control brain magnetic resonance imaging that showed total agenesis of the corpus callosum and colpocephaly. At his arrival, a neurological examination was normal with no signs of intracranial hypertension. His intelligence quotient was unaltered and he scored normal in the Mini-Mental State Examination test. The literature reviewed here suggested that patients with agenesis of the corpus callosum require a strict neurocognitive follow-up during postnatal life, as they may present neuropsychological deficits during adolescence, when development of the corpus callosum is completed and there is maximum reliance on this structure. Thus, our patient was scheduled for future annual neurocognitive testing.ConclusionsIsolated agenesis of the corpus callosum is not innocuous, and patients with this defect require a strict neurocognitive follow-up. We provide an informative reference tool useful for the postnatal neuropsychological screening of patients with isolated agenesis of the corpus callosum.