Head Ultrasound
Table of Content (clickable)
Papile's classification for intraventricular hemorrhage (IVH):
Grade I: restricted to germinal matrix subependymal area
Grade II: hemorrhage is extending inside the normally-sized ventricle (will usually fill less than 50% of the ventricle)
Grade III: hemorrhage with extension into a dilated ventricle (typically fills more than 50% of the ventricle)
Grade IV: hemorrhage that extends in the parenchyma
Patient with no IVH
Sagittal view
Coronal view
Head ultrasound without IVH in an extreme premature newborn showing brain immaturity
Full scan examples of premature infants with no IVH
Mild asymmetry in ventricular sizes. IVH grade 2 on the right and grade 2/3 on the left.
Patient with interventricular hemorrhage grade 4 on the right side and grade 3 on the left side:
Example of a sweep identifying the anterior cerebral artery with the pericallosal artery
Pulse-wave Doppler in the pericallosal artery identifying the systolic and diastolic flow velocities. This patient has normal anterograde diastolic flow.
Anterior Cerebral Artery (ACA): The anterior cerebral artery (ACA) is one of the major arteries supplying blood to the brain. It arises from the internal carotid artery and is part of the Circle of Willis. The ACA supplies blood to the medial portions of the frontal lobes, parietal lobes, and the superior medial regions of the cerebral hemispheres, including the corpus callosum.
The pericallosal artery is the terminal branch of the ACA. It runs along the corpus callosum, specifically on its superior aspect, and gives off several branches that supply the brain's medial structures. It courses parallel to the corpus callosum within the interhemispheric fissure. Branches: Callosomarginal artery, which supplies parts of the frontal and parietal lobes. Other small branches to the medial surfaces of the brain.
PSV = Peak Systolic Velocity / EDV = End Diastolic Velocity
How to evaluate arterial cerebral Doppler flows.
Coronal view outlining the systolic and diastolic phase, with anterograde flow, in the anterior cerebral artery.
Sagittal view outlining the systolic and diastolic phase, with anterograde flow, in the anterior cerebral artery.
Sagittal view outlining the diastolic retrograde flow, in the middle cerebral artery.
Coronal view outlining the Circle of Willis, with the cursor on the middle cerebral artery
Anterior cerebral artery by Doppler colour, going in front of the lateral ventricle.
Peak systolic velocity (PSV) is 0.31 m/s
End diastolic velocity (EDV) is 0.09 m/s
Mean velocity (TAMX: time averaged maximum velocity) is 0.17 m/s
Velocity time integral (VTI) - estimation of stroke distance - 6.9 cm
Resistive index (RI) is PSV-EDV/PSV = (0.31-0.09)/0.31 = 0.71
Pulsatility index = PSV - EDV / TAMX = (0.31-0.09)/0.17= 1.29
Another example of Anterior Cerebral Artery Doppler by Colour Doppler through the Sagittal view in the Trans-Fontanelle approach
Transcranial Doppler (TCD)
Examples of transcranial Doppler when one may appreciate the Circle of Willis. The middle cerebral artery is seen coming towards the probe.
Middle Cerebral Artery Doppler via TCD:
PSV: 0.80 m/s
EDV: 0.12 m/s
Mean velocity: 0.375 m/s
RI: 0.85
PI:0.81
IVH grade 3 (left) and 4 (right) with intraventricular dilatation
Right-sided grade III and left-sided grade IV IVH with retracting intraventricular clot.
Bilateral grade 4 IVH
Full scan of premature infants with bilateral IVH grade 3 or bilateral grade 4
IVH grade 3 bilateral
IVH grade4 bilateral
HUS.pdf
Ventricular dilatation and scoring
