A Closer Look at a Small Brain: Transnuchal Ultrasound Facilitates High-Resolution Imaging of the Cerebellum in Preterm Infants

Abstract

Purpose Very preterm infants are at risk for cerebellar injury and impaired cerebellar growth with adverse neurodevelopmental outcome. Ultrasound through the mastoid fontanel (MF) with a curved-array or sector probe is the most established method for the sonographic examination of the cerebellum. The goal of our study was to examine the validity of transnuchal ultrasound through the foramen occipitale magnum (FOM) with a linear probe for monitoring postnatal cerebellar growth.

Methods Retrospective analysis of routine ultrasound scans through FOM and MF in 105 preterm infants born between 23 and 36 weeks of gestation with a birthweight of less than 1500 g.

Results Diameters of the cerebellar hemispheres obtained through the two acoustic windows mastoid fontanel and foramen occipitale magnum showed high correlations (r’s = 0.981 and 0.983, p’s < 0.001). Corrected gestational age was significantly associated with transverse cerebellar diameter (TCD) on the first scan (r = 0.908, p < 0.001) as well as postnatal cerebellar growth (r = 0.920, p < 0.001). Postnatal growth was slightly decreased resulting in cerebellar growth restriction on serial scans. Both associations exceeded the calculated ratio of TCD to head circumference (r = 0.657, p < 0.001) and TCD to biparietal diameter with gestational age (r = 0.705, p < 0.001).

Conclusion Transnuchal ultrasound is feasible for examination of the preterm cerebellum and improves image quality compared to scans through the MF with higher resolution at a very short distance. Monitoring cerebellar growth during early postnatal life via transnuchal ultrasound can help to identify children at high risk for neurodevelopmental impairment.

Zusammenfassung

Ziel Bei extrem Frühgeborenen besteht das Risiko für Kleinhirnschädigungen und für eine Beeinträchtigung des Kleinhirnwachstums mit nachteiligen Auswirkungen auf die neurologische Entwicklung. Ultraschall durch die Mastoid-Fontanelle (MF) mit einer gekrümmten Array- oder Sektorsonde ist die etablierteste Methode zur sonografischen Untersuchung des Kleinhirns. Ziel unserer Studie war es, die Validität von transnuchalem Ultraschall durch das Foramen occipitale magnum (FOM) mittels Linear-Schallkopf zur Überwachung des postnatalen Kleinhirnwachstums zu untersuchen.

Methoden Retrospektive Analyse von Routine-Ultraschalluntersuchungen durch FOM und MF bei 105 Frühgeborenen zwischen 23 und 36 Schwangerschaftswochen mit einem Geburtsgewicht von weniger als 1500 g.

Ergebnisse Die Durchmesser der Kleinhirnhemisphären, die durch die beiden akustischen Fenster von MF und FOM gemessen wurden, zeigten hohe Korrelationen (r’s = 0,981 und 0,983; p < 0,001). Das korrigierte Gestationsalter war signifikant mit dem transversalen Kleinhirndurchmesser (TCD) beim ersten Scan (r = 0,908; p < 0,001) sowie dem postnatalen Kleinhirnwachstum (r = 0,920; p < 0,001) assoziiert. Das postnatale Wachstum war leicht vermindert, was zu einer Einschränkung des Kleinhirnwachstums bei seriellen Scans führte. Beide Assoziationen übertrafen die berechnete Ratio von TCD zum Kopfumfang (r = 0,657; p < 0,001) und von TCD zum biparietalen Durchmesser (r = 0,705; p < 0,001) gegenüber dem Gestationsalter.

Schlussfolgerung Transnuchaler Ultraschall kann für die Untersuchung des Zerebellums des Frühgeborenen eingesetzt werden und verbessert, im Vergleich zu Aufnahmen durch die MF, die Bildqualität bei höherer Auflösung in sehr kurzer Distanz. Die Überwachung des Kleinhirnwachstums mittels transnuchalem Ultraschall in der frühpostnatalen Phase kann helfen, Kinder mit hohem Risiko für neurologische Entwicklungsstörungen zu identifizieren.

Key words

preterm - cerebellum - ultrasound - foramen occipitale magnum

Publication History

Received: 17 August 2019

Accepted: 07 November 2019

Article published online:
08 January 2020

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