CRANIAL ULTRASOUND

Question 1

Ultrasound imaging of the head uses sound waves to produce pictures of the brain and cerebrospinal fluid.
-It is most commonly performed on infants, whose skulls have not completely formed.

Answer 1

cranial ultrasound

Question 2

A transcranial Doppler ultrasound

Answer 2

evaluates blood flow in the brain’s major arteries.

Question 3

are two types of cranial ultrasound exams used to evaluate brain tissue and the flow of blood to the brain, respectively.

Answer 3

Head and transcranial Doppler

Question 4

produces images of the brain and the cerebrospinal fluid that flows and is contained within its ventricles, the fluid filled cavities located in the deep portion of the brain.

Since ultrasound waves do not pass through bone easily, this exam is most commonly performed on infants, whose skulls have not completely formed.

Answer 4

head ultrasound examination

Question 5

The gaps between those skull bones provide a “? ,” allowing the ultrasound beam to freely pass into and back from the brain. The ultrasound probe and some gel are placed on the outside of the head in one of those regions without bone.

Answer 5

window

Question 6

• an ultrasound evaluates both the direction and velocity of the blood flow in the major cerebral arteries of the brain.
  -This type of ultrasound exam is also used during surgical procedures to monitor blood flow in the brain.
  -Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. -They can also show blood flowing
  through blood vessels.

Answer 6

transcranial Doppler (TCD)

Question 7

TCD may be used alone or with other
diagnostic exams such as

Answer 7

-magnetic resonance imaging (MRI),
-magnetic resonance angiography (MRA)
-computed tomography (CT) scans.

Question 8

is a routine exam for infants who were born prematurely.
The procedure is used to screen for brain
conditions associated with prematurity,
such as bleeding or brain tissue damage.
If detected, follow-up ultrasound exams
will be performed.

Answer 8

Head ultrasound

Question 9

In infants, head ultrasound is used to:

Answer 9

-evaluate for hydrocephalus/enlargment of ventricles
-detect bleeding within the brain tissue
-assess whether there is damage to the white matter brain tissue
-evaluate for congenital abnormalities.
-locate the site of an infection or tumor.

Question 10

bleeding within the brain tissue or the ventricles. The latter condition is called

Answer 10

intraventricular hemorrhage (IVH)

Question 11

assess whether there is damage to the white matter brain tissue surrounding the edges of the ventricles, a condition known as

Answer 11

periventricular leukomalacia (PVL).

Question 12

In adults, head ultrasound is used to

Answer 12

locate and evaluate tumor masses during brain surgery, facilitating their safe removal.

Question 13

Transcranial Doppler ultrasound is used to -assess the risk of ? in adults and children with ?

Answer 13

stroke
sickle cell disease.

Question 14

TCD measure conditions affecting blood flow to and within the brain, such as:

Answer 14

-Stenosis:
-Vasospasm:

Question 15

: a narrowing of a segment of a vessel,
most commonly due to atherosclerosis
(hardening of the arteries).

Answer 15

Stenosis

Question 16

: a temporary narrowing of a vessel,
usually a reaction to blood being present in the spinal fluid spaces surrounding the brain. This condition is known as subarachnoid hemorrhage (SAH).

Answer 16

Vasospasm

Question 17

blood being present in the spinal fluid spaces surrounding the brain.
This condition is known as ?

Answer 17

subarachnoid hemorrhage (SAH)

Question 18

A head ultrasound is performed in the ?) at the infant’s bedside.
The infant is positioned lying ?
A clear, water-based gel is applied to the transducer to help the transducer make secure contact with the body and eliminate air pockets that can block the sound waves from passing into the body.

The sonographer or radiologist then gently presses the transducer against the ? (soft spot of the infant’s head, which has no bone to block the passage of the sound waves).

Answer 18

neonatal intensive care unit (NICU
face-up.
fontanelle

Question 19

During a transcranial Doppler ultrasound, the patient is either positioned on his or her back on an examination table or ? in an examination chair.
A clear water-based gel is applied on the ?, above and lateral to the ?, in front of the ? or over the ?, as these are sites for blood vessels that supply the brain.

Answer 19

seated upright
back of the neck
cheek bone
ear
eyelid

Question 20

During a transcranial Doppler ultrasound,
The transducer is gently pressed over one of these areas to measure the ? and ?of the flowing blood.

The patient will need to remain still during the examination, which may take up to ?minutes.

Answer 20

direction and speed
35 minutes

Question 21

Benefits of ultraound

Answer 21

-noninvasive
-no pain
-widely available, easy-to-use and less expensive
-extremely safe and does not use radiation.
-clear picture of soft tissues that do not show up well on x-ray images.

Question 22

the limitations of cranial ultrasound

Answer 22

-very sensitive to motion,
-Large patients are more difficult

Question 23

Exam results could be altered, due to:

Answer 23

-an open wound or recent surgical incision near the area being imaged.

-changes in blood flow pattern as a result of heart disease or irregular heart rhythms.

Question 24

For a routine scan, the ? serves as the acoustic window.

Answer 24

anterior (bregmatic) fontanelle

Question 25

Additional acoustic windows, used for visualizing specific intracranial structures:

Answer 25

-the posterior (lambdoid) fontanelle, -mastoid fontanelle, -squamosal part of the temporal bone (i.e. temporal window), -foramen magnum, -coronal suture, and -squamosal sutures.

Question 26

? transducer is best suited for viewing the neonatal brain through the fontanelles while affording good depth

Answer 26

7.5-8 MHz micro convex

Question 27

a ?, usually ?-? MHz, can be used in addition, for a more detailed depiction of superficial structures and lesions

Answer 27

linear transducer 11-12 MHz

Question 28

? transducer can be used if the fontanelle is small, e.g. at a later age in infancy, but has anarrower field of view and is generally less favored

Answer 28

phased array

Question 29

To be sure, the brain of an extremely premature neonate (i.e. ? weeks or less) will appear less developed than that of a term neonate, including less convoluted ? and shallower ?; the following should only serve as a rough guide

Answer 29

28 weeks gyri sulci

Question 30

On a ? scan, the transducer is first angulated anteriorly, then gradually rotated posteriorly.

Answer 30

coronal (transverse) scan

Question 31

The following structures should be sought and assessed during coronal transverse scan:

Answer 31

-level of frontal lobes: -level of frontal horns of lateral ventricles: -level of the foramen of Monro: -level of the bodies of the lateral ventricles: -level of the trigones of the lateral ventricles: -through the parieto-occipital lobes: naturally, the skull should appear on all acquisitions

Question 32

frontal lobes, interhemispheric fissure, orbits

Answer 32

level of frontal lobes:

Question 33

-frontal lobes, -interhemispheric fissure, -corpus callosum, -frontal horns, -cavum septi pellucidi, -caudate nucleus, -basal ganglia, - temporal poles, -Sylvian fissures

Answer 33

level of frontal horns of lateral ventricles:

Question 34

-frontal lobes, -interhemispheric fissure, -corpus callosum, -cavum septi pellucidi, -caudate nucleus, -basal ganglia, -temporal lobes, -Sylvian fissures -frontal horns -cingulate sulcus, -choroid plexus in ventricles,

Answer 34

level of the foramen of Monro:

Question 35

-interhemispheric fissure, -corpus callosum, -bodies of lateral ventricles with choroid plexus, -caudate nucleus, -basal ganglia, -temporal horns of lateral ventricles, -temporal lobes, -Sylvian fissures, -parahippocampal gyrus, -parietal lobes, -midbrain, -tentorium -cerebelli, -cerebellar hemispheres and vermis -third ventricle,

Answer 35

level of the bodies of the lateral ventricles:

Question 36

- interhemispheric fissure, -corpus callosum, -parietal lobes, -trigones of the lateral ventricles with choroid plexus, -occipital lobes, -calcarine fissure -cavum vergae (in preterm neonates or as an anatomical variant),

Answer 36

level of the trigones of the lateral ventricles:

Question 37

-calcarine fissure, -parietal lobes, -occipital lobes -cingulate sulcus, -parieto-occipital fissure (well-formed in term neonates),

Answer 37

through the parieto-occipital lobes:

Question 38

the transducer is positioned at the midline, then angulated all the way to the extreme right and from there gradually ack to the midline. After having arrived back at the midline (i.e. the midsagittal structures are visible again), the same scan should be repeated on the left.

Answer 38

On a sagittal (longitudinal) scan,

Question 39

The following structures should be assessed in On a sagittal (longitudinal) scan:

Answer 39

-midsagittal: -extreme parasagittal plane (right/left): -parasagittal plane though the insula: -parasagittal plane though the (right/left) lateral ventricle: -

Question 40

: cingulate sulcus, corpus callosum, cavum septi pellucidi, cavum vergae (premature neonates or variant), third ventricle, fornix, midbrain, pons, medulla, cerebellar vermis, calcarine fissure, parieto-occipital fissure, quadrigeminal plate, fourth ventricle, cisterna magna, interpeduncular cistern, Sylvian aqueduc

Answer 40

midsagittal

Question 41

-Sylvian fissure, -insular cortex, -precentral, central, and -postcentral sulci

Answer 41

extreme parasagittal plane (right/left):

Question 42

-frontal lobe, -temporal lobe, -Sylvian fissure, -parietal lobe, - occipital lobe, -insular cortex and sulci (in premature neonates, -the latter gradually become visible as the infant matures), -precentral, central, and -postcentral sulci

Answer 42

parasagittal plane though the insula:

Question 43

parasagittal plane though the (right/left) lateral ventricle: frontal lobe, caudate nucleus, basal ganglia, thalamus, temporal lobe, cingulate sulcus, lateral ventricle - frontal horn, body, occipital horn, and temporal horn, choroid plexus; parahippocampal gyrus, cerebellar hemisphere, parietal lobe, parieto-occipital fissure, occipital lobe

Answer 43

parasagittal plane though the (right/left) lateral ventricle: