Real-time Ultrasound Scans Research Articles

Direct – Maternal Genetic Parameters Estimated for Real-Time Ultrasound Scan Measures of Eye Muscle Area, Rib Fat Depth, and their Correlation with Body Weight in Male Philippine Riverine Buffaloes

Background: Ultrasound scanning is a non-invasive technique for evaluating animals based on carcass yield and meat quality traits. It has been incorporated into the beef cattle breeding program. However, little has been done in buffaloes. Thus, this study was conducted to estimate the genetic parameters for growth traits- body weights (BW) and a real-time ultrasound scan of eye muscle area (EMA) and rib fat (RF) to determine their suitability as a tool for selection.
 Methods: Four hundred thirty-eight (438) male Philippine riverine buffaloes with 1,535 BW records and 417 real-time ultrasound scans of EMA and RF scans at the 12th rib were available for the study. BW was taken and adjusted at birth, 6, 12, 18, 24, 30, and 36 months while RF and EMA scans were taken at 12 & 18 mos. Genetic parameters were estimated with a pedigree-based multi-trait animal model using ASREML software.
 Results: The average BW of buffaloes adjusted to 6, 12, 18, 24, 30, and 36 months of age were 135kg, 230.8kg, 323.0kg, 382.7, 453.6, and 502.4kg, respectively. The mean EMA and RF at 12 months were 29.7 cm2 and 3.2mm, respectively. Direct genetic heritabilities were 0.26±0.16, 0.29±0.12, 0.35±0.19 and 0.67±0.32 for birth, BW12mos, EMA12mos and RF12mos, respectively. Maternal genetic heritability for birth weight. was 0.12±0.09. Genetic correlations among traits were positive except between birth and RF.
 Conclusions: Results indicate that ultrasound scanning can be used for selection together with BW at 12mos. and suggest that early performance is an excellent predictor of performance at a later age.

Percutaneous Microwave Ablation of Hepatocellular Carcinoma with "Double Fusion" Technique: Technical Note and Single-Center Preliminary Experience.

Percutaneous image-guided thermal ablation is included in most society guidelines for treatment of hepatocellular carcinoma (HCC). The results of this treatment in terms of efficacy depend on the ability to precisely place the device into the target tumor. Ultrasound (US) is a commonly used imaging guidance modality for its real-time feedback. However, an accurate device deployment remains challenging in some clinical scenarios, including cases of tumors that are undetectable or not clearly visible by US. To overcome this problem, fusion imaging techniques have been developed, which combine images from different modalities. The most widely known technique combines pre-procedural contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) with real-time US scans. Cone beam CT (CBCT) is a technology that can provide intra-procedural cross-sectional images, which can be registered to images from other modalities, including preprocedural CT/MR scans. The aim of our study is to report the preliminary experience on percutaneous microwave ablation (MWA) of patients with HCC that were treated using the "double fusion" technique, which combines the use of US fusion imaging and CBCT fusion imaging. We describe the technical details, feasibility, safety and short-term efficacy of this technique in a small series of eight patients with 11 HCCs.

A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

IntroductionKidney biopsy is an important tool for making diagnoses and for assessing the drug treatment requirements and disease prognosis in the management of kidney diseases. There are variations in the rate of complications associated with kidney biopsies across countries, and this depends on various clinical and technical factors. The aim of this study is to report on complications associated with kidney biopsy performed in low- and middle-income countries.MethodsTwo reviewers searched studies in MEDLINE, Embase, Cochrane Reviews, and African Journals Online. A random effects meta-analysis method was used to pool estimates of complications.ResultsWe identified 39 studies reporting on 19,500 kidney biopsies with overall complications (major + minor) rate of 14.9% (95% confidence interval = 11.4%–18.7%). Fewer complications were reported in biopsies performed with real-time ultrasound scans compared to those pre-marked using ultrasound or blind procedures (12.4% vs. 14.9% vs. 24.5%; P = 0.037), respectively. Complications, albeit lower for procedures performed with automated needles (13.3%), were not significantly different from those performed with nonautomated needles (17.3%; P = 0.588). Major complications included macroscopic hematuria (1.48%), nephrectomy (0.04%), blood loss requiring red cell transfusion (0.24%), angiographic intervention (0.22%), and death (0.01%).ConclusionComplications associated with kidney biopsy in low- and middle-income countries are low, are comparable to those in other settings, and occur more sparingly when real-time ultrasound techniques or automated kidney biopsy needles are used. This suggests the need to expand the use of this procedure to improve diagnosis of kidney pathologies and choice of therapy when indicated.

Interobserver Reliability of Neonatal Cranial Ultrasound Scanning Regarding White Matter Disease

Thus far, few studieshave investigated the reliability or accuracy of CUS. This isan interesting observation as far as randomized controlledtrials and interventional studies involving premature infantsoften include severe CUS abnormalities among study out-comes. The aim of the study was to assess the interobserverreliability of CUS regarding the diagnosis of white matterdisease (WMD) between neonatologists and to assess theaccuracy of local interpretations of neonatologists withdifferent degrees of experience compared to a centralreader (radiologist).The current study was based on consecutive CUS in-vestigations of 28 neonates performed in 2004 (done byB.R.). Diagnoses were verified by a pediatric radiologist(M.R.), which served as the diagnostic “gold standard”. Sixneonatologists (Observers 1e6) re-examined the CUS in2010 by using a standardized protocol that is also used fordaily routine at our neonatal intensive care unit andtherefore well known by all the observers. The six readersincluded four consultants with experience in CUS for morethan 10 years and two residents having attended theneonatal ward for 1 year. The readers were blinded to theaim of the study that was to assess the interobserver reli-ability between neonatologists on reading CUS regardingWMD. Real-time ultrasound scans were performed with acommercially available unit (Philips/Advanced TechnologyLaboratories Inc., Bothell, WA, USA) using a 7.5-MHztransducer, and multiple images were obtained accordingto standard CUS procedures.Periventricular echodensities (PVEs) were defined asconfluent areas of increased echogenicity nearly compa-rable with the echogenicity of the choroid plexus. Theconfirmation of the findings in both the coronal andsagittal planes was required prior to a definitive diagnosisof PVE could be made. Periventricular leukomalacia (PVL)was described in terms of the cysts being anterior to thefrontal horn of the lateral ventricle, parietal and lateral tothe body of the lateral ventricle, or occipital being adja-cent and lateral to the occipital horn of the lateralventricle.

Effect of body composition on diet selection in finishing pigs1

The objective of this work was to determine if pigs of similar BW, but differing in 10th-rib backfat thickness, would differ in their selection of dietary protein. The first experiment was conducted with gilts and was designed in a 2 x 2 factorial arrangement with the main effects of body fat (lean vs. fat) and feeding program (single vs. choice). Crossbred gilts (n = 32) with an initial BW of 79 kg were sorted into high (2.24 cm, fat) and low backfat (1.51 cm, lean; P < 0.001) groups based on real-time ultrasound scans at the 10th rib. Diets were 1) a low-protein corn-based diet supplemented with crystalline AA (8.5% CP, 0.58% Lys) and 2) a high-protein corn- and soybean meal-based diet (22.7% CP, 1.275% Lys). During wk 1, all pigs were fed a 50:50 mix of the low-protein and high-protein diets. From d 7 to 28, one-half the pigs in the lean and fat groups were given a choice of low- and high-protein diets in separate feeders, whereas the others remained on the 50:50 mix. Initial differences in 10th-rib backfat thickness were maintained through d 28 (fat, 3.02 cm; lean, 2.42 cm; P < 0.001). Circulating leptin concentrations were greater in the fat pigs than in the lean pigs (3.84 vs. 3.35 ng/mL; P < 0.05). Average daily gain (1.06 kg/d) and ADFI (2.64 kg/d) were not different between treatment groups. However, the pattern of selection was different in the choice groups such that lean pigs consumed more (64.4%) of the high-protein diet than did fat pigs (35.6%, P < 0.01), resulting in a difference in the percentage of protein consumed (lean = 16.9% CP; fat = 12.8% CP; P < 0.01). A second experiment of similar design, but with barrows (n = 32; initial BW 69 kg), was conducted. Barrows classified as fat had 2.33 cm of 10th-rib backfat as compared with 1.75 cm in the lean group (P < 0.01). The percentage of protein in the diet selected by the fat barrows was not different from that selected by the lean barrows (15.9 vs. 17.4%). The lack of difference in selection pattern in barrows may be accounted for by the relatively smaller difference in body composition between the fat and lean classifications in the barrows in the choice feeding program as compared with body composition of the gilts. These results demonstrate that gilts of similar BW, but differing in composition, likely have different nutrient requirements and diet selection patterns. Although allowing pigs to self-select did not alter growth rate, the results indicated that diet selection can be used to allow pigs to meet their individual nutrient requirements more closely.

Predicting Carcass Composition in Early-Weaned Simmental Steers Using a Combination of Real-time Ultrasound, Live Evaluation, Carcass Expected Progeny Differences, and GeneSTAR Marbling Marker

Early-weaned Simmental steers (n = 192) were individually fed over 4yr (48 head/ yr) to determine if real-time ultrasound (RTU), live evaluation, carcass expected progeny differences, GeneSTAR marbling, or a combination could accurately predict marbling composition. Steers were fed a high-concentrate diet for 249.7 ± 0.7 d and harvested at 423.3 ± 1.4 d of age. The RTU scans were recorded for ribeye area, intramuscular fat (IMF), and back fat thickness at 60-d intervals with final ultrasound scans taken ≤ 13 d prior to harvest. Yearling BW, marbling (MARB), percentage of retail cuts, and carcass weight expected progeny differences were calculated for each steer. Visual estimations of quality and yield grade were made ≤ 7 d prior to pre-harvest by 3 evaluators. Average price data over 5yr were used for dressed beef, grid premiums, and discounts. GeneSTAR did not affect (P > 0.10) IMF deposition. Genetic, live, and carcass parameters were regressed on chemical IMF, dressed price, and profit using stepwise regression analysis. For chemically determined IMF, 67.0% of the variation was explained by RTU quality grade (R2 = 0.585), percentage of retail cuts (R2 = 0.030), and MARB (R2 = 0.028), indicating that RTU was the only major contributor. Approximately 17% of the variation in average dressed price was explained by RTU. GeneSTAR MARB marker was not an accurate indicator of intramuscular deposition of early-weaned Simmental steers; however, MARB expected progeny difference (EPD) was correlated to IMF deposition. Live evaluation better estimated yield grade than quality grade. Real-time ultrasound most accurately predicted MARB, carcass value, and profit.

Role of imaging modalities in ovarian tumors

Ž . Today, real-time ultrasound scans US are considered routine gynecological procedures. Ž . Computed tomography CT and magnetic resoŽ . nance imaging MRI have also begun to play important roles as diagnostic tools in gynecology 1 3 . In this study, the criterion of inclusion was the curative operation of ovarian tumors after CT and or MRI following US. We analyzed 101 cases to clarify the usefulness and cost-performance of additional imaging modalities. The final diagnoses of benign, borderline, and malignant tumors were made in 45, 11 and 45 cases, respectively 4 . US was followed by CT in 80 cases, and US was followed by both CT and MRI in the 21 remaining cases. The number of cases examined, as well as new and accurate information regarding the CT and or MRI modalities added to US findings toward a final diagnosis. The added procedures were regarded as ‘useful’ when the new findings

Monitoring Changes in Carcass Quality Across Time-on-Feed Using Real-Time Ultrasound to Optimize Marketing Endpoints11Research was supported by the Idaho Cattle Association.

Abstract Seventy-one Limousin-Angus-cross heifers (11 mo of age; 341 kg) were used to monitor changes in subcutaneous fat thickness (FT), ribeye area (REA), and intramuscular fat percentage (IMF) across time-on-feed (TOF) using real-time ultrasound. Real-time ultrasound scans of FT, REA, and IMF were taken at 0, 29, 57, 84, 101, and 120 d. Following the ultrasound scan on d 120, heifers were harvested at a commercial packing plant. At 72 h postmortem, carcass data were collected on all carcasses, and short loins were removed from 18 USDA Choice carcasses for chemical analysis. Ultrasound data were analyzed using the general linear model of SAS with TOF as the main effect and animal by TOF as the error term. Subcutaneous FT increased (P 2 = 0.64, standard error of prediction (SE p ) = 0.15) across TOF. Ribeye area increased (P 2 = 48.51 + 0.38 × TOF, d; r 2 = 0.77, SE p = 8.77) across TOF. Intramuscular fat percentage increased (P 2 , d − 0.000002 × TOF 3 , d; R 2 = 0.83, SE p = 0.46) across TOF. Quality grade (UQG) was estimated from the IMF (>5.0% = Choice). The percentage of the heifers predicted to grade Choice from IMF was 22, 81, and 82% at d 84, 101, and 120 d on feed, respectively. At slaughter, 82% of the heifer carcasses graded Choice with yield grades of 1 and 2. Standard errors of prediction for ultrasound REA, FT, and IMF were 7.03 cm 2 (n = 71), 0.30 cm (n = 71), and 0.45% (n = 18), respectively. The correlation for total lipid content of longissimus muscle (n = 18) and IMF was 0.62; in contrast, the correlation for total lipid content and marbling score was 0.04. Real-time ultrasound proved to be a useful tool to monitor changes in FT, REA, and IMF and optimize marketing endpoints for both high quality and cutability.

Evaluation of the twin peak or lambda sign in determining chorionicity in multiple pregnancy

To assess prospectively the diagnostic capabilities of ultrasound assessment, using the twin peak or lambda sign, in determining chorionicity in multiple pregnancy. Fifty-five cases of multiple pregnancy were assessed. Real-time ultrasound scans of the origin of the inter-twin membrane for the presence or absence of the twin peak/lambda sign were performed and permanent images recorded. Chorionicity was determined by placental pathologic analysis. Presence or absence of the twin peak/lambda sign as determined by real-time ultrasound correctly predicted chorionicity in 34 of 36 dichorionic and seven of eight monochorionic twin pregnancies: sensitivity for dichorionicity 94%, specificity 88%, positive predictive value 97%, and negative predictive value 78%. Real-time assessment was superior to analysis of permanent films. Ultrasound assessment of chorionicity using the twin peak/lambda sign has high sensitivity and specificity, but accuracy may not be sufficient to guide clinical management in all cases.

Tetralogy of Fallot: prenatal diagnosis and postnatal survival.

To correlate prenatal echocardiographic findings with infant outcome in a large screening population affected by tetralogy of Fallot. Inclusion criteria required confirmed postnatal cardiac diagnosis, at least one fetal ultrasound examination with satisfactory heart visualization, and infant delivery at our institution. Aortic and pulmonary artery diameters were measured from real-time ultrasound or videotaped scans and compared against published nomograms. The pulmonary artery to aorta ratio was also evaluated in a similar manner. Infant survival was assessed 1 year after delivery. Seventeen fetuses were confirmed to have a ventricular septal defect and an overriding aorta with varying degrees of right ventricular outflow obstruction after delivery. All karyotypes were normal. Ultrasound screening identified 12 of 17 abnormal hearts at a mean gestational age of 22.9 +/- 5.1 weeks; two of these fetuses were thought to have only ventricular septal defect before delivery. Five fetuses had enlarged aortic roots during the initial scan. Only two of the ten fetuses with a measurable pulmonary artery had initial sonographic evidence for valve stenosis. Six other pulmonary arteries became abnormally small with advancing pregnancy. The pulmonary artery to aorta ratio was decreased in six of the ten fetuses with a measurable pulmonary artery. Sixteen infants survived at least 1 year after birth and successfully completed either corrective or palliative cardiac surgery. Fetuses with tetralogy of Fallot may present with only a ventricular septal defect and aortic septal override by prenatal ultrasound examination. Pulmonary artery stenosis is not always present at initial ultrasound examination, but this finding can develop or worsen during pregnancy. Furthermore, a normal aortic diameter does not exclude tetralogy of Fallot. Infant survival appears to be favorable in the absence of other major structural or chromosomal anomalies.

Tetralogy of fallot: prenatal diagnosis and postnatal survival

To correlate prenatal echocardiographic findings with infant outcome in a large screening population affected by tetralogy of Fallot. Inclusion criteria required confirmed postnatal cardiac diagnosis, at least one fetal ultrasound examination with satisfactory heart visualization, and infant delivery at our institution. Aortic and pulmonary artery diameters were measured from real-time ultrasound or videotaped scans and compared against published nomograms. The pulmonary artery to aorta ratio was also evaluated in a similar manner. Infant survival was assessed 1 year after delivery. Seventeen fetuses were confirmed to have a ventricular septal defect and an overriding aorta with varying degrees of right ventricular outflow obstruction after delivery. All karyotypes were normal. Ultrasound screening identified 12 of 17 abnormal hearts at a mean gestational age of 22.9 ± 5.1 weeks; two of these fetuses were thought to have only ventricular septal defect before delivery. Five fetuses had enlarged aortic roots during the initial scan. Only two of the ten fetuses with a measurable pulmonary artery had initial sonographic evidence for valve stenosis. Six other pulmonary arteries became abnormally small with advancing pregnancy. The pulmonary artery to aorta ratio was decreased in six of the ten fetuses with a measurable pulmonary artery. Sixteen infants survived at least 1 year after birth and successfully completed either corrective or palliative cardiac surgery. Fetuses with tetralogy of Fallot may present with only a ventricular septal defect and aortic septal override by prenatal ultrasound examination. Pulmonary artery stenosis is not always present at initial ultrasound examination, but this finding can develop or worsen during pregnancy. Furthermore, a normal aortic diameter does not exclude tetralogy of Fallot. Infant survival appears to be favorable in the absence of other major structural or chromosomal anomalies.

Intracranial Lesions in the Fullterm Infant with Hypoxic Ischaemic Encephalopathy: Ultrasound and Autopsy Correlation

To test the hypothesis that cranial ultrasound correlated with post-mortem findings in neonates with hypoxic ischaemic encephalopathy (HIE), the brains of 20 infants who died after at least two real time ultrasound scans were examined. The ultrasound abnormalities detected in the periventricular/subcortical white matter, cortex or thalami were compared with the macroscopic and histological appearances. Comparing the last ultrasound scan which was performed no longer than 12 hours before the infant died, with histological data, the sensitivity and specificity for lesions in the thalamus was 100% and 83.3% respectively; for cortical lesions 76.9 and 100% respectively and for lesions in the periventricular white matter 80% and 75% respectively. The value of cranial ultrasound for detecting intracranial abnormalities in infants with HIE was considerably better than reported previously. This could mainly be attributed to the use of a 10 MHz transducer which was of critical importance to identify lesions in the superficial cortical layer.

US-assisted bronchoscopy with use of miniature transducer-containing catheters.

To demonstrate the value of ultrasound (US) guidance during flexible bronchoscopic procedures in a series of patients with known or suspected pulmonary neoplasms. US-guided bronchoscopy was carried out as an adjunct to conventional bronchoscopy for the diagnosis of mediastinal, hilar, or parenchymal neoplasms in 25 patients with masses previously detected with chest radiography or computed tomography. Miniature transducer-containing catheters were inserted through the biopsy port of the flexible bronchoscope, and cross-sectional real-time US scans of tumors, lymph nodes, and blood vessels were obtained. Among six cases of peripheral masses and 19 cases of central masses, additional information was provided in 18 cases (72%). This information was used to choose the optimal site for transmural biopsy. These preliminary results suggest that this US procedure may become an important diagnostic tool during bronchoscopy, due to the ability to identify structures beyond the lumen of the tracheobronchial tree.

Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack.

Doppler and real-time ultrasound (US) were performed to evaluate the extent of atherosclerotic changes in the carotid artery and to assess their relationship to prevalent cerebrovascular disease. Real-time US scans and Doppler measurements of the carotid arteries were analyzed in 5,201 subjects aged 65 years or older. Severity of atherosclerotic lesions was associated with increased frequencies of hyperechoic, irregular, and heterogeneous textured lesions (P < .0001). The severity of internal carotid artery stenosis was associated with thickening of the intima-media layer of the common carotid artery wall (r = .37, P < .0001). A history of stroke and transient ischemic attack (TIA) was more likely when hyperechoic, heterogeneous, and irregular lesions were seen in the carotid artery. Internal carotid artery stenosis correlated better with prevalent stroke and TIA than did sonographic descriptions of plaque texture. However, the prevalence of hyperechoic, heterogeneous, and irregular lesions increased as the degree of internal carotid stenosis increased. On real-time images alone, the average of the internal carotid artery maximal wall thickness is the sonographic measure of atherosclerosis that enables the best prediction of prevalent stroke and TIA.

Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants

Real time ultrasound scans using an ATL 300C sector scanner with 5-7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty-six long-term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1-21.2%; grade 2-4.8%; grade 3-3.4%; grade 4-4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al. Overall, 120 infants (82.2%) were unimpaired and 6.2% had mild, 3.4% had moderate, 4.1% had severe and 4.1% had multiply severe impairment. The major factors associated with impairment were gestational age less than 28 weeks, birthweight less than 1000 g, vaginal delivery, respiratory distress syndrome, mechanical ventilation, pulmonary air leaks and CVH. When these factors were reanalysed in a logistic regression model for odds ratios, only CVH (P less than 0.005) and birth by spontaneous vaginal delivery (P less than 0.05) were significant. The prevalence of impairment was 11.4% with no CVH, 6.5% grade 1, 71% grade 2, 20.0% grade 3 and 100.0% grade 4 CVH. The sensitivity of CVH of grade 2 or greater as a screening test was 64.7% for impairment, 78.6% for cerebral palsy and 70% for severe intellectual handicap. The mean general quotient (GQ) (Griffiths) at 2 years for infants with CVH was 89.1, and 97.5 for those without CVH (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Twin gestations: monitoring of complications and anomalies with US.

An evaluation of 227 consecutive twin gestations was undertaken to assess the role of ultrasound (US) in the diagnosis of major obstetric complications and congenital anomalies. US accurately depicted the growth and development of fetuses in 65 patients with underlying maternal disorders that produced additional risks to the pregnancy. Complications such as malpresentations (104 cases), polyhydramnios (15 cases), oligohydramnios (five cases), and uterine myomas (seven of 11 cases) were demonstrated prenatally with US. Fetal anomalies included anencephaly (two cases), hydrocephalus (two cases), conjoined twins (three cases), twin-twin transfusion syndrome (five cases), and acardiac monsters (two cases). Demise of one twin in 20 gestations and demise of both twins in 18 gestations (overall mortality of 17%) were correctly identified with US. These 38 gestations included intrauterine demise in 12, spontaneous abortion in 13, and neonatal deaths in 13. Therefore, when multiple gestations are suspected clinically, serial real-time US scans should be obtained beginning in the first trimester.

Head size, brain growth, and lateral ventricles in very low birthweight infants.

Ninety eight newborn infants weighing less than 1500 g at birth and with gestational ages from 26 to 32 weeks were followed prospectively. They were grouped according to real time ultrasound scans in the neonatal period: infants in group A (n = 20) had periventricular haemorrhage (PVH) and normal ventricles; infants in group B (n = 26) had PVH and dilated ventricles (none with clinical hydrocephalus); and infants in group C, who formed the control group (n = 52), had no PVH and normal ventricles. At outpatient follow up a static image ultrasound scanner was used to measure the width of the lateral ventricles and brain hemispheres. The three groups of infants showed similar growth in occipitofrontal circumference, biparietal diameter, and brain hemispheres irrespective of a history of PVH or ventricular dilatation. The relation of ventricle size to biparietal diameter was similar in those infants in groups A (PVH alone) and C (controls) who had a good outcome. About a third (n = 8) of the infants in group B had persistent ventricular dilatation in relation to biparietal diameter and a poor outcome associated with developmental delay and cerebral palsy. By contrast, the remaining two thirds (n = 18) of the infants in group B who later had smaller ventricles in relation to biparietal diameter showed fewer neurodevelopmental sequelae. It is suggested that persistent ventricular dilatation in relation to biparietal diameter at follow up carries a bad prognosis, which might be due to brain atrophy.

Gelatin Sign: Ultrasonographic Evidence of Cerebral Necrosis in Infants

Since its introduction, real-time ultrasonographic imaging of the neonatal brain has proven valuable in detecting a variety of pathologic and anatomic disturbances of the newborn brain.1-3 High resolution scanning heads, bedside technique, and video recording also allow study of the intracranial movement and responses to intrinsic and extrinsic forces. This paper reports six cases of infants with severe brain disease of widely different etiologies, in which abnormal response was found to cranial percussion, termed the "gelatin sign." MATERIALS AND METHODS A total of 506 consecutive real-time cranial ultrasound scans were obtained in 333 cases from a Level 3, regional neonatal intensive care unit. The scans were ordered by attending neonatologists to study the CNS in low birth weight infants and infants suspected of having intracranial disease.

Ultrasound measurement of the ventricular size in newborn infants

High resolution real-time ultrasound scans were obtained through the anterior fontanelle to measure the lateral ventricles of 540 neonates of various gestational ages. Coronal scans showed that the distance between the falx and the lateral wall of the body of the lateral ventricle (ventricular index) and the greatest axis of the lateral ventricle (ventricular axis) were correlated with increasing gestational age. Growth charts were constructed for neonates of various gestational ages, from 24 to 40 weeks. The greatest distance perpendicular to the ventricular axis was defined as the ventricular depth. The depth of normal lateral ventricles was 0.18 cm (range, 0.13-0.23 cm). Hopefully, the data concerning ventricular sizes obtained in this survey can be utilized for the early diagnosis and control of posthemorrhagic ventriculomegaly.

PRIMARY THALAMIC HAEMORRHAGE IN THE NEWBORN: A NEW CLINICAL ENTITY

4 healthy full-term babies presented between 11 and 14 days of age with neurological abnormalities. Eye signs in 3 suggested involvement of tracts closely related to the thalamus. Spontaneous intrathalamic haemorrhage was confirmed with computed tomography and real-time ultrasound scans. Ventricular dilatation occurred in 3 babies and 2 of these needed ventriculoperitoneal shunts. The short-term neurodevelopmental outcome was fairly good.