"Ultrasound measurements of the lateral ventricles in neonates: A comparison of multiple measurements methods." Poster No.: C-1557 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit I. Oulad Abdennabi, J. Bakker; Dordrecht/NL Hemorrhage, Dilatation, Structured reporting, Ultrasound, Pediatric, Neuroradiology brain 10.1594/ecr2014/C-1557 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 9
Learning objectives Ultrasound measurements of the lateral ventricles in neonates: an explanation of the available methods, the correct execution, the reproducibility and sensitivity. Background Measurement of the ventricular size by ultrasound is important to diagnose early posthaemorrhagic ventricular dilatation. Ventricular dilatation is usually a complication of haemorrhage in the caudothalamic groove in premature infants and can lead to increased intra-cranial pressure due to obstruction of liqour drainage. Since clinical symptoms are manifesting late, ultrasonographic measurement of the ventricular size is essential. There are various measurement methods, but these are not used consistently in daily clinical practice. Images for this section: Page 2 of 9
Fig. 1: Caudothalamic groove Page 3 of 9
Findings and procedure details The ventricle index, which is better known as the Levene, is the distance from the falx to the lateral boundary of the lateral ventricle. This is measured in the coronal plane just posterior or at the level of the foramen of Monro. It is the most commonly described method and has the largest reference database. However the ventricle index only shows a clear increase in severe hydrocephalus. The ventricle index is often confused with the ventricular hemispheric ratio, the width of the horns as a ratio to the hemispheric width, which is less sensitive to ventricular dilatation in the first few weeks post-partum. The anterior horn width, better known as the Davies, is the maximum diagonal width of the horn, measured in the same plane as the ventricle index and is more sensitive to mild ventricular dilatation and is easy to reproduce. The Thalamo-occipital distance is measured in the sagittal plane and is the distance from the thalamus to the tip of the dorsal horn. This measurement is most sensitive to mild dilatation because lateral ventricle dilatation manifests itself first in the occipital horns, however this measurement is difficult to reproduce and error measurements are made easily. Ventricle measurements including the third ventricle, the fourth ventricle and the ventricle height are not frequently used. More importantly is to describe the shape of the ventricle. With the increasing pressure after a cerebral bleeding, the ventricle shape becomes rounder, this phenomenon is called "ballooning". Images for this section: Page 4 of 9
Fig. 2: Ventricle index & Anterior horn width Page 5 of 9
Fig. 3: Anterior horn width Page 6 of 9
Fig. 4: Thalamo-occipital distance Page 7 of 9
Fig. 5: Ballooning Page 8 of 9
Conclusion Ultrasound measurements of the lateral ventricles play an important role in the early recognition of post-haemorrhagic ventricular dilation. Of the available lateral ventricles measurements, the anterior horn width has a good sensitivity and reproducibility. The ventricle index has a lower sensitivity for mild dilatation but has the most comprehensive references. Personal information Ikrame Oulad Abdennabi, 2nd year Radiology resident, Albert Schweitzer ziekenhuis, Dordrecht, the Netherlands. References New Reference Values for the Neonatal Cerebral Ventricles. M.J. Brouwer, 2011 Ultrasound measurements of the lateral ventricles in neonates: why, how and when? A systematic review, M.J. Brouwer, 2010 Reference ranges for the linear dimensions of the intracranial ventricles in preterm neonates. Davies, 2000 Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Malcolm Levene, 1981 Page 9 of 9