This lecture prides 8 easy steps of scanning the neonatal brain through anterior fontanelle ,followed by examples of most commonly encountered abnormalities.

1. Neonatal transcranial
ultrasound...The normal ,and
abnormal .
Dr/Ahmed Bahnassy
Consultant Radiologist
PSMMC

3. Technical considerations
1.choosing the probe.
2.adjusting depth and
focus.
3.adjusting gain.
4.right and left labelling.
5.planes consideration.
6.use of previous scans
for moving heads

4. Planes and landmarks
coronal
sagittal

5. Coronal scan 1

6. Coronal scan 2

7. Coronal scan 3

8. Coronal scan 4

9. Coronal 5

10. Importance of standardizing scans
Brain diagram showing a coronal view as seen
in ultrasound by greater fontanel. this explain
some usefull measurements for ultrasound in
neonatal brain: 1- Lateral ventricle (posterior
horn): normal ≤ 13mm 2 - Third ventricle:
normal ≤ 10mm 3 - Interhemispheric fissure:
normal ≤ 6mm 4 - Subarachnoid space ≤ 4mm

11. Midline sagittal

12. Para-sagittal 1

13. Para-sagittal 2

14. Para-sagittal 3

15. Other imaging planes

18. Germinal matrix
Highly vascular structure that gives rise
to nerve cells.
Just above the caudothalamic groove
and beneath ependymal lining of
ventricles.
Begins to involute at 3rd month of
gestation and complete by 36 week.
Source of bleeding in premature
infants.

19. Germinal matrix haemorhage(acute)

20. Resolving haemorhage

21. Grades II and III

22. Grade IV

23. Periventricular echogenicity
According to van Wezel et al.
•
Grade 0: normal echogenicity of the
periventricular white matter ( less than that
of the choroid plexus)
•
Grade 1: moderately increased echogenicity
of the periventricular white matter, the
affected region being almost as bright or as
bright as the choroid plexus .
Grade 2: seriously increased echogenicity,
the affected region being obviously brighter
than the choroid plexus ....
•
Separate notation: homogeneous, nonhomogeneous .

24. Periventricular leukomalacia

25. Subarachnoid and subdural collections

26. Ischaemic injury
• Hyperechogenic areas in
thalamus .caudate
nucleus...watershed
areas.
Low RI
Compensatory
mechanism.

27. Abnormal (cyst )!!

28. Using doppler

29. Posterior fossa abnormality
Arnold Chiari malformation
Dandy walker complex

30. Missing structure 1
normal

31. Missing structure 2
normal

32. Missing structure 3
normal

33. abnormal (canal )

34. abnormal echogenic shadows.

35. Structure too large