© Borgis - New Medicine 1/2001, s. 51-54
Andrzej Koczynski1, Zofia Rajtar-Leontiew2
Ultrasonographic scanning of the central nervous system in the newborn and neonates: a relative assessment
1Department of Radiology and Ultrasonography Clinical Hospital
2Department of Neonatal Pathology The Medical University of Warsaw
The quality of ultrasound examination is associated with technical equipment and diagnostic methods. Interpretation based on „overreading ” or „underreading ” images may yield false results. The development of imaging techniques has resulted in eliminating invasive diagnostic x-ray procedures.
Visualisation depends on technical conditions and a diagnostic technique. Every imaging procedure has a limited reliability which provides the grounds for proper assessment based on appropriate perception. In the assessment of a complex picture the measurement of reliability consists of a purposeful disregard of areas which might lead to „overreading ” or „underreading ”. It is equally important to eliminate artefacts. Assessment of such areas may yield false results. Each imaging techniques has a definite diagnostic power which is a vehicle for a particular amount of relevant information affecting the quality of results.
Ultrasound examination (USG) is a highly valued means of clinical diagnosis because it is an easily accessible, simple, noninvasive, informative and cost-effective procedure.
Cranial sonography is the basic imaging assessment technique in the central nervous system in the newborn and infants, and a vital part of a thorough clinical examination. The significance of the procedure can be measured by its well-established place in almost every diagnostic, monitoring, and follow-up process. The well-documented role of the technique has been demonstrated by the increasing number of procedures and growing clinical and imaging experience reported in literature (1, 2, 3, 4, 5).
The present paper focusses on the necessity of establishing an objective assessment of the USG examination by indicating the likelihood of inadequate and even false images. Another aim is to emphasise the significance of the procedural evolution in the basic imaging technique. The paper also includes results of USG examinations carried out on patients admitted to the Department of Neonatal Pathology. The radiological pictures have been submitted by the Radiological Department archives and demonstrate cases treated before the USG procedure was introduced.
The technological progress has become a valid factor in enforcing a changing approach to the diagnostic process. A good example might be to compare the value of different imaging techniques of the head: a radiological scan showing the skull (fig. 1) and cranial sonography showing the brain (fig. 2). Regardless of the different value of the techniques and time period in which they were used, each is distincly exclusive (fig. 3).
Fig. 1. A normal radiological scan of the neurocranium.
Fig. 2. A normal USG scan of the brain.
Fig. 3. Craniofenestria - `windows´ in the cranial vault.
A rational joint use of imaging techniques, strictly dependent on clinical indications, increases the evidence area in terms of both quantity and quality.
A positive development in procedural evolution was the complete replacement of pneumocephalography, ventriculography and subdurography by USG techniques (fig. 4, 5, 6, 7).
Fig. 4. Ventriculography: markedly enlarged lateral ventricles.
Fig. 5. Subdurography: extensive defects of the brain tissue in the frontal area.
Fig. 6. Cranial sonography: marked enlargement of the lateral ventricles.
Fig. 7. Cranial sonography: marked dilation of the submeningeal spaces.
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