Ch 2 U/S of Neonatal Brain

Question 1

When does the anterior fontanelle window close?

Answer 1

Begins around 9 months + is completely closed by 15 months

Question 2

What is the main imaging window used for imaging the neonatal brain?

Answer 2

Anterior fontanelle

(others include posterior + mastoid fontanelle)

Question 3

Which probe should we use?

Answer 3

-High frequency 7-10 MHz curved or sector probe m/c used

-High frequency 10-15 MHz linear probe for superficial structures can be used

Question 4

What 3 structures are on our diagnostic checklist when scanning a neonatal brain?

Answer 4

-Ventricles (normal or dilated)
-Parenchyma (developing landmarks)
-Pulsation + extra axial spaces

Question 5

When performing a neonatal brain exam, we want to know if the child is under/over ___ weeks?

Answer 5

32 weeks

Question 6

How many images are there in the coronal protocol?

Answer 6

6-8

Question 7

The right side of the brain is labelled on the ___ side of the image in the coronal protocol?

Answer 7

Left

Question 8

Which fontanelle do we start imaging at with the coronal protocol?

Answer 8

Start at front of brain in anterior fontanelle, then slice through different locations moving more posterior

Question 9

What coronal view is the most anterior image taken?

Answer 9

Coronal view 1

Question 10

Which coronal view is taken through the frontal lobes at the level of the orbits + shows the interhemispheric fissure?

Answer 10

Coronal view 1

Question 11

Which coronal view shows the frontal horns of the LVs + the CSP in between?

Answer 11

Coronal view 2

Question 12

Which coronal view shows the frontal horns + is slightly more posterior?

Answer 12

Coronal view 3 (not always included in protocol)

Question 13

Which coronal view is at the level of the foramen of monro, 3rd ventricle, CSP + sylvian fissures?

Answer 13

Coronal view 4

Question 14

Which view do we measure the LVs?

Answer 14

Coronal view 4

Question 15

Which coronal view shows the choroid plexus, sylvian fissures, tentorium, cerebellar hemispheres, cisterna magna + is posterior to 3rd ventricle?

Answer 15

Coronal view 5

Question 16

Which coronal view shows the quadrigeminal cistern, thalami, cerebellum + choroid?

Answer 16

Coronal view 6

Question 17

Which coronal view shows the trigones of the LVs + is the level where the glomi of the CP fills most of LVs?

Answer 17

Coronal view 7

Question 18

Which coronal view should we compare the periventricular parenchyma to the CP?

Answer 18

Coronal view 7

(parenchyma should NOT be brighter than the CP)

Question 19

What coronal view is the most posterior image taken?

Answer 19

Coronal view 8

Question 20

Which coronal view is at the level of the occipital lobe, shows the posterior aspect of the interhemispheric fissure + shows normal echogenic periventricular white matter?

Answer 20

Coronal view 8

Question 21

Which coronal view is not always included in the protocol?

Answer 21

Coronal view 3

Question 22

How many coronal + SAG views are there?

Answer 22

COR: 8
SAG: 5

Question 23

Where do we put our probe to image the brain in SAG?

Answer 23

Rotate 90 degrees from coronal in anterior fontanelle

Question 24

The anterior/front of the brain is on the left side of the image in the SAG plane, how do we label this?

Answer 24

Label RT, LT or ML depending where we are angled

Question 25

Which SAG view is directly midline?

Answer 25

SAG view 1

Question 26

Which SAG view shows the hypoechoic CC above the CSP/vergae, 3rd + 4th ventricle, cerebellar vermis + CM?

Answer 26

SAG view 1

Question 27

The CC is surrounded by the ___ artery?

Answer 27

Pericallosal

Question 28

Is vergae seen in all neonatal brains?

Answer 28

No, only premies

Question 29

Which SAG view shows the caudothalamic groove?

Answer 29

SAG view 2

Question 30

The caudothalamic groove is formed by what 2 structures?

Answer 30

Head of caudate nucleus + thalamus

Question 31

What is the m/c site for hemorrhage in premies?

Answer 31

Germinal matrix (seen in SAG view 2)

Question 32

Which SAG view shows the LV + the CP tapering to a point in the caudothalamic groove?

Answer 32

SAG view 3 (may need multiple images here with oblique angles to vis whole LV)

Question 33

Is the frontal or occipital horn more medial?

Answer 33

Frontal

Question 34

Which SAG view will show the glomus of the CP filling the trigone LV?

Answer 34

SAG view 4

Question 35

Which SAG view shows the sylvian fissures, branches of the MCA + is lateral to the ventricles?

Answer 35

SAG view 5

Question 36

List 3 additional imaging planes used?

Answer 36

-Posterior fontanelle -Mastoid (posterolateral) fontanelle -Superior SAG sinus

Question 37

When would we image via the posterior fontanelle?

Answer 37

When assessing the occipital (posterior) horn of the LV (place probe at mid/back of head)

Question 38

When would we image via the mastoid fontanelle?

Answer 38

When assessing the posterior fossa/cerebellum (place probe just behind ear)

Question 39

When would we image via the superior SAG sinus?

Answer 39

When assessing the midline venous sinus + want to doppler for patency (place probe in SAG at anterior fontanelle)