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Neonatal Transcranial Ultrasound: An Evaluation of Thermal Hazard for Clinical Equipment
Abstracts Kwandong University College of Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul/KR Purpose: To evaluate the characteristics and the significance of the perisutural superficial echogenic lesions (PSEL) involving brain parenchyma and leptomeningeal space in neonatal cranial ultrasonography (US). Material & Methods: We evaluated the clinical records and neuroimaging studies of twenty neonates who showed echogenic lesions in perisutural superficial region on neonatal cranial US. MRI and CT were taken in 9 and 1 neonate in each. Results: The echogenic lesions in US were parenchymal lesions accompanying with subarachnoid hemorrhage (SAH). MRI showed restricted diffusion along the cortex in six of seven neonates. The locations of the lesions were mainly parietal and frontal (six and five in each). Five lesions were detected in other areas (occipital in three and temporal in two). There were accompanying intracranial lesions not detected on US in all cases on MRI and CT scan, which were subdural hemorrhage in four, intraventricular hemorrhage in two, subarachnoid hemorrhage in other area in two and border zone infarction in four. There was no accompanying lesion in one neonate. Conclusion: The PSEL involving both brain parenchyma and leptomeningeal space in neonatal cranial US is mainly SAH and associated parenchymal infarction. More hemorrhagic and infracted lesions are accompanied in other areas. Therefore, concerning to the perisutural superficial region is important during the neonatal cranial US to detect PSEL which can be the indicator of more extensive accompanying lesions.
SS 36.03 Neonatal Transcranial Ultrasound: An Evaluation of Thermal Hazard for Clinical Equipment A. Shaw,1 G. Memoli,1 F. Duck,2 J. Osborne,2 B. Zeqiri1 1 Acoustics and Ionizing Radiation Division, National Physical Laboratory, Teddington/UK, 2Royal United Hospital, Bath/UK Purpose: This talk will describe the last stage of a project, funded by the Radiation Protection Programme of the UK Department of Health. The overall aim was to use validated, anatomically relevant phantoms to survey the temperature increase caused by neonatal clinical ultrasound equipment. Material & Methods: We developed a robust thermal phantom and instrumentation which mimics the dimensions and key ultrasonic and thermal properties of the neonatal head and which measures the temperature at four locations on an axis perpendicular to the fontanel. We visited and carried out an audit of neonatal transcranial ultrasound equipment in 20 UK Hospitals and made temperature measurements using the phantom on a total of 148 output configurations. Additionally, we measured acoustic output power and transducer surface temperature using an infra-red camera and recorded the mechanical and/or thermal Indices to investigate how well they correlate with temperature rise. Results: We found that only heating close to the transducer was significant. Approximately 35% of the mode configurations studied gave a temperature increase at the phantom skin surface in excess of 6 C. Such a configuration applied to a neonatal head with a skin temperature close to 37 C could elevate the skin temperature above the permitted contact temperature for adult skin. Conclusion: This talk will summarise the project, concentrating on the findings of the audit of clinical equipment.
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SS 36.04 Preliminary Study of Congenital Internal Jugular Phlebectasia in Children with Ultrasonography W. Qiao,1 Q. X. Mo,1 L. Qin,1 T. Yi,1 W. Chun,2 P. Z. Xia,2 C. J. Yu1 1 Ultrasound Department, the Children’s Hospital Chongqing Medical University, Chongqing/CN, 2Pediatric Surgery Department, the Children’s Hospital Chongqing Medical University, Chongqing/CN Purpose: To research the ultrasonography characteristic of congenital internal jugular phlebectasia in children. Material & Methods: 106 children with congenital internal jugular phlebectasia were divided into patient group. 83 normal internal jugular veins were applied as normal control group. All veins were received by ultrasonography and velocity vector image(VVI). Maximum of velocity (Vmax), maximum of strain (Smax) and maximum of strain rate (SRmax) of 4 segments were measured, which were analysed by VVI automatic analysis software. Results: Combining with Valsalva’s breathing test, the average expanding ratio of maximal transverse diameters was 2.460.626 and that of the maximal antero-posterior diameters was 3.58861.238 in the patient group. During Valsalva examination, turbulent flow and lower flow velocity in the dilated veins were detected with CDFI. 2) Smax of posterior wall were higher than those of anterior wall. Conclusion: Ultrasonography and VVI technology could diagnose the congenital internal jugular phlebectasia, and provid useful information.
SS 36.05 Contrast Enhanced Ultrasound Assisted Sclerotherapy of an Infantile Lymphangioma J. M. Ju¨ngert, M. Zapke, M. Schroth, H. Von Gossel Paediatrics, Clinic for Children and Adolescent, University, Erlangen/DE Purpose: The therapy of lymphangiomas is not standardised. One therapeutic option is sclerotherapy, especially if the cysts are communicating. This can be visualised by an injection of contrast agent and X-ray. Our purpose was to visualise a possible communication of the cysts by contrast enhanced ultrasound (CEUS). Material & Methods: A newborn girl had a subcutaneous lymphangioma in the left axilla at birth. Because of missing regression and limitation of the left arm movements an attempt of sclerotherapy was indicated. Sonographically guided (General Electric E9), the largest cyst was punctured. Approximately 0.05 - 0.1 ml of the ultrasound contrast agent SonovueÒ (Bracco) and 0.4 ml solution of sodium chloride were injected. Results: The bubbles dispended in all visible cysts. Therefore, the communication between all cysts was confirmed. The injection of OK 432 (PicibanilÒ) for sclerotherapy could be performed directly without the puncture of other cysts. We did not see any adverse side effect of SonovueÒ. After seven months only a residual subcutaneous lesion with a single cyst of 7 mm could be detected sonographically. There was no more limitation of the arm movements left. Conclusion: We report a successful CEUS assisted sclerotherapy of an infantile lymphangioma. Based on our experience CEUS seems to be an alternative in the detection of communicating cysts in lymphangiomas in children, avoiding the application of X-ray. This method can be helpful for the therapeutic strategy.
SS 36.06 Colour Coded Duplex Sonography is Superior to MRI in the Evaluation of Infantile Haemangioma P. Urban, M. Poetke, C. M. Philipp, U. Mu¨ller, H. P. Berlien
SS 36.03 Neonatal Transcranial Ultrasound: An Evaluation of Thermal Hazard for Clinical Equipment A. Shaw,1 G. Memoli,1 F. Duck,2 J. Osborne,2 B. Zeqiri1 1 Acoustics and Ionizing Radiation Division, National Physical Laboratory, Teddington/UK, 2Royal United Hospital, Bath/UK Purpose: This talk will describe the last stage of a project, funded by the Radiation Protection Programme of the UK Department of Health. The overall aim was to use validated, anatomically relevant phantoms to survey the temperature increase caused by neonatal clinical ultrasound equipment. Material & Methods: We developed a robust thermal phantom and instrumentation which mimics the dimensions and key ultrasonic and thermal properties of the neonatal head and which measures the temperature at four locations on an axis perpendicular to the fontanel. We visited and carried out an audit of neonatal transcranial ultrasound equipment in 20 UK Hospitals and made temperature measurements using the phantom on a total of 148 output configurations. Additionally, we measured acoustic output power and transducer surface temperature using an infra-red camera and recorded the mechanical and/or thermal Indices to investigate how well they correlate with temperature rise. Results: We found that only heating close to the transducer was significant. Approximately 35% of the mode configurations studied gave a temperature increase at the phantom skin surface in excess of 6 C. Such a configuration applied to a neonatal head with a skin temperature close to 37 C could elevate the skin temperature above the permitted contact temperature for adult skin. Conclusion: This talk will summarise the project, concentrating on the findings of the audit of clinical equipment.
S71
SS 36.04 Preliminary Study of Congenital Internal Jugular Phlebectasia in Children with Ultrasonography W. Qiao,1 Q. X. Mo,1 L. Qin,1 T. Yi,1 W. Chun,2 P. Z. Xia,2 C. J. Yu1 1 Ultrasound Department, the Children’s Hospital Chongqing Medical University, Chongqing/CN, 2Pediatric Surgery Department, the Children’s Hospital Chongqing Medical University, Chongqing/CN Purpose: To research the ultrasonography characteristic of congenital internal jugular phlebectasia in children. Material & Methods: 106 children with congenital internal jugular phlebectasia were divided into patient group. 83 normal internal jugular veins were applied as normal control group. All veins were received by ultrasonography and velocity vector image(VVI). Maximum of velocity (Vmax), maximum of strain (Smax) and maximum of strain rate (SRmax) of 4 segments were measured, which were analysed by VVI automatic analysis software. Results: Combining with Valsalva’s breathing test, the average expanding ratio of maximal transverse diameters was 2.460.626 and that of the maximal antero-posterior diameters was 3.58861.238 in the patient group. During Valsalva examination, turbulent flow and lower flow velocity in the dilated veins were detected with CDFI. 2) Smax of posterior wall were higher than those of anterior wall. Conclusion: Ultrasonography and VVI technology could diagnose the congenital internal jugular phlebectasia, and provid useful information.
SS 36.05 Contrast Enhanced Ultrasound Assisted Sclerotherapy of an Infantile Lymphangioma J. M. Ju¨ngert, M. Zapke, M. Schroth, H. Von Gossel Paediatrics, Clinic for Children and Adolescent, University, Erlangen/DE Purpose: The therapy of lymphangiomas is not standardised. One therapeutic option is sclerotherapy, especially if the cysts are communicating. This can be visualised by an injection of contrast agent and X-ray. Our purpose was to visualise a possible communication of the cysts by contrast enhanced ultrasound (CEUS). Material & Methods: A newborn girl had a subcutaneous lymphangioma in the left axilla at birth. Because of missing regression and limitation of the left arm movements an attempt of sclerotherapy was indicated. Sonographically guided (General Electric E9), the largest cyst was punctured. Approximately 0.05 - 0.1 ml of the ultrasound contrast agent SonovueÒ (Bracco) and 0.4 ml solution of sodium chloride were injected. Results: The bubbles dispended in all visible cysts. Therefore, the communication between all cysts was confirmed. The injection of OK 432 (PicibanilÒ) for sclerotherapy could be performed directly without the puncture of other cysts. We did not see any adverse side effect of SonovueÒ. After seven months only a residual subcutaneous lesion with a single cyst of 7 mm could be detected sonographically. There was no more limitation of the arm movements left. Conclusion: We report a successful CEUS assisted sclerotherapy of an infantile lymphangioma. Based on our experience CEUS seems to be an alternative in the detection of communicating cysts in lymphangiomas in children, avoiding the application of X-ray. This method can be helpful for the therapeutic strategy.
SS 36.06 Colour Coded Duplex Sonography is Superior to MRI in the Evaluation of Infantile Haemangioma P. Urban, M. Poetke, C. M. Philipp, U. Mu¨ller, H. P. Berlien