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Neonatal Cerebral Investigation

Details

  • 357 b/w illus. 91 colour illus.
  • Page extent: 310 pages
  • Size: 276 x 219 mm
  • Weight: 1.33 kg

Library of Congress

  • Dewey number: 618.92/8047543
  • Dewey version: 22
  • LC Classification: RJ488 .N46 2008
  • LC Subject headings:
    • Pediatric neurology--Diagnosis
    • Newborn infants--Diseases--Diagnosis
    • Brain--Imaging
    • Cerebrovascular Disorders--diagnosis
    • Electroencephalography

Library of Congress Record

Hardback

 (ISBN-13: 9780521838481)

Neonatal Cerebral Investigation

Cambridge University Press
9780521838481 - Neonatal Cerebral Investigation - Edited by Janet M. Rennie, Cornelia F. Hagmann and Nicola J. Robertson
Frontmatter/Prelims


Neonatal Cerebral Investigation

SECOND EDITION

Edited by

JANET M. RENNIE

CORNELIA F. HAGMANN

NICOLA J. ROBERTSON



Neonatal Cerebral Investigation

SECOND EDITION

Edited by

JANET M. RENNIE
Consultant and Senior Lecturer in Neonatal Medicine

CORNELIA F. HAGMANN
Clinical Lecturer and Honorary Consultant Neonatologist

NICOLA J. ROBERTSON
Senior Lecturer in Neonatology and Honorary Consultant Neonatologist

UCL Elizabeth Garrett Anderson Institute for Women’s Health
University College London Hospitals
London UK



CAMBRIDGE UNIVERSITY PRESS
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© Cambridge University Press 2008

This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.

First published 2008

Printed in the United Kingdom at the University Press, Cambridge

A catalog record for this publication is available from the British Library

Library of Congress Cataloging in Publication data
Neonatal cerebral investigation / editors, Janet M. Rennie, Cornelia F. Hagmann, Nicola J. Robertson.
p.   ;   cm.
Rev. ed. of: Neonatal cerebral ultrasound / Janet M. Rennie. 1997.
Includes bibliographical references.
ISBN-13: 978-0-521-83848-1
1.  Pediatric neurology – Diagnosis.   2.  Newborn infants – Diseases – Diagnosis.   3.  Brain – Imaging.[DNLM: 1.  Cerebrovascular Disorders – diagnosis.   2.  Electroencephalography. 3.  Infant, Newborn.   4.  Magnetic Resonance Imaging. 5.  Ultrasonography. WL 355 N438 2008]    I. Rennie, Janet M.    II. Hagmann, Cornelia F.    III. Robertson, Nicola J. IV.  Rennie, Janet M. Neonatal crebral ultrasound.
RJ488.N46   2008
618.92′8047543–dc22   2007051667


ISBN 978-0-521-83848-1 hardback

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.



Contents

List of contributors   page vi
Preface  vii
Acknowledgements  viii
Glossary and abbreviations   ix
Section I. Physics, safety, and patient handling  1
1Principles of ultrasound  1
JEREMY C. HEBDEN and JANET M. RENNIE
2Principles of EEG  9
GERALDINE B. BOYLAN
3Principles of magnetic resonance imaging and spectroscopy  22
NICOLA J. ROBERTSON, ENRICO DE VITA, and ERNEST B. CADY
Section II. Normal appearances  45
4Normal neonatal imaging appearances  45
JANET M. RENNIE, CORNELIA F. HAGMANN, and NICOLA J. ROBERTSON
5The immature brain  66
JANET M. RENNIE, CORNELIA F. HAGMANN, and NICOLA J. ROBERTSON
6The normal EEG and aEEG  83
GERALDINE B. BOYLAN, DEIRDRE M. MURRAY, and JANET M. RENNIE
Section III. Solving clinical problems and interpretation of test results  92
7The baby with a suspected seizure  92
JANET M. RENNIE, CORNELIA F. HAGMANN, and NICOLA J. ROBERTSON
8The baby who was depressed at birth  130
JANET M. RENNIE, CORNELIA F. HAGMANN, and NICOLA J. ROBERTSON
9The baby who had an ultrasound as part of a preterm screening protocol  173
JANET M. RENNIE, CORNELIA F. HAGMANN, and NICOLA J. ROBERTSON
10Common maternal and neonatal conditions that may lead to neonatal brain imaging abnormalities  210
NICOLA J. ROBERTSON, CORNELIA F. HAGMANN, and JANET M. RENNIE
11The baby with an enlarging head or ventriculomegaly  235
CORNELIA F. HAGMANN, JANET M. RENNIE, and NICOLA J. ROBERTSON
12The baby with an abnormal antenatal scan: congenital malformations  248
CORNELIA F. HAGMANN, JANET M. RENNIE, and NICOLA J. ROBERTSON
13The baby with a suspected infection  269
ANDREW B. KAPETANAKIS, CORNELIA F. HAGMANN, and Janet M. Rennie
14Postmortem imaging  281
CORNELIA F. HAGMANN, NICOLA J. ROBERTSON, and JANET M. RENNIE
Index  284


Contributors

JANET M. RENNIE MA MD FRCP FRCPCH DCH
Consultant and Senior Lecturer in Neonatal Medicine
UCL Elizabeth Garrett Anderson Institute for Women’s Health
University College London Hospitals
London UK

CORNELIA F. HAGMANN MD FMH PAEDIATRICS AND NEONATOLOGY
Clinical Lecturer and Honorary Consultant Neonatologist
UCL Elizabeth Garrett Anderson Institute for Women’s Health
University College London Hospitals
London UK

NICOLA J. ROBERTSON PHD FRCPCH
Senior Lecturer in Neonatology and Honorary Consultant Neonatologist
UCL Elizabeth Garrett Anderson Institute for Women’s Health
University College London Hospitals
London UK

GERALDINE B. BOYLAN PHD
Senior Lecturer in Medical Education and Paediatrics
School of Medicine
University College Cork
Ireland

ERNEST B. CADY FINSTP
Clinical Scientist and Section Head MR Physics UCLH NHS Trust
Director Bloomsbury Centre for Magnetic Resonance Spectroscopy
Honorary Lecturer UCL
Department of Medical Physics and Bioengineering
UCLH NHS Foundation Trust
London UK

ENRICO DE VITA PHD
Magnetic Resonance Physicist
Department of Medical Physics and Bio-Engineering
University College London Hospitals NHS Foundation Trust
London UK

JEREMY C. HEBDEN PHD
Professor of Medical Physics and Bioengineering
University College London
London UK

ANDREW B. KAPETANAKIS MBBS MRCP MRCPCH
Imaging Fellow and Neonatologist
UCLH NHS Foundation Trust
London UK

DEIRDRE M. MURRAY MBBS MRCPI
Research Fellow
Department of Paediatrics and Child Health
University College Cork
Ireland



Preface

The natural anxiety experienced by all new parents about the well-being and future of their child is increased when the baby is born small or ill, and is further heightened if there is any concern about the function of the brain. As clinicians involved in the care of newborns with neurological problems, and who are often asked to advise parents whose fetus is thought to have a neurological abnormality, we have considerable experience with the situations we describe in this book. Over the years we have sought advice from others, searched the literature, and consulted and read widely in order to solve clinical problems on a daily basis. This book represents a summary of the results of our knowledge and experience, and we have started with the clinical presentation of neonatal neurological disease rather than using a pathological or end-stage neuroimaging classification. We describe our approach to the problem and the way we interpret the results of the investigations we request, and hope others will find this approach useful as they strive to provide the best possible care to their vulnerable patients.

By the time this book is published it will be almost 30 years since the first ultrasound images of the neonatal brain were made at University College London Hospital and published in the Lancet. There have been huge advances since then, and the field has moved on considerably in the decade since the first edition of this book was published, as Neonatal Cerebral Ultrasound written by Janet M. Rennie. The wealth of detailed information that modern imaging produces has far exceeded the expectations which were envisaged in the early days of ultrasound imaging in the 1980s. Magnetic resonance imaging (MRI) is much more readily obtainable, and digital technology allows prolonged electroencephalogram (EEG) recordings to be made at the cotside. Ultrasound is still an important tool, but we have expanded the scope and the material to include the full range of investigations now available, and we have indicated when MRI and EEG are particularly helpful.

For convenience, we have adopted masculine pronouns when referring to babies, and feminine when referring to neonatologists. We hope that this will not offend anyone who reads the book.

JANET RENNIE, CORNELIA HAGMANN, NICOLA ROBERTSON



Acknowledgements

Peter Silver never gave up hoping and believing that a second edition of Neonatal Cerebral Ultrasound would eventually appear, and since his departure from Cambridge University Press Deborah Russell and her team have been unfailingly enthusiastic and supportive. We thank Deborah for her patience and for remaining cheerful as each new deadline came and went without sight of any material, and for her tolerance as the count of words and figures steadily rose. Doreen Robertson has redrawn many of the figures, and we are very grateful to her for giving so freely of her time and skill.

The literature and knowledge base have exploded in the last 10 years, and we are eternally grateful to our contributors. Their expertise on specific topics is greater than our own, and we very much appreciate the time they gave up to help us in this enterprise. We have received much help and advice from Rox Gunny, our neuroradiologist, and her colleagues at Great Ormond Street Children’s Hospital and the National Hospital for Neurology and Neurosurgery Queen Square; also Ronit Pressler, pediatric neurophysiologist at Great Ormond Street Children’s Hospital. Dr Lyn Chitty, in fetal medicine, made very helpful comments on the appropriate parts of the text and lent us several images, for which we are grateful. Many of the images could not have been obtained without the help of our nursing staff, whose dedicated care ensures that we can perform MRI on even the sickest baby safely. We could not have made such rapid progress in imaging quality without the help of a superb NHS medical physics department, and we would like to thank all those involved.

This work was undertaken at University College London Hospital (UCLH)/University College London (UCL) who received a proportion of funding from the Department of Health’s National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

The cover photograph of Elliot Bowden, a very special baby to us all, is reproduced with grateful thanks to his parents. He represents many others, and we take this opportunity to extend our thanks to the parents of all our patients, who have allowed us to share their hopes and fears, to advise and inform them, and to walk with them on what is so often a difficult and stressful journey. In particular, we would like to acknowledge all those parents who have allowed us to enrol their babies into research studies over the years; without them, the advances which we report in this book would not have been possible.

We cannot finish the acknowledgements without thanking our partners: Ian Watts, Jürg Schlumpf, and Dominique Acolet. They have patiently endured many broken social engagements and evenings alone, and shouldered more than their share of household chores during the hours we have spent with our computers. We dedicate this book to them, with gratitude and much love.



Glossary and abbreviations

Acoustic impedance A fundamental property of tissue. Ultrasound is reflected at boundaries between tissues of different impedance

Acoustic shadow An area that is poorly visualized with ultrasound due to the fact that most of the beam energy has been reflected by a boundary above it

Adenosine diphosphate (ADP) Produced in energy reactions when ATP monodephosphorylates

Adenosine triphosphate (ATP) The key metabolite in biological energy reactions

Advanced method for accurate, robust, and efficient spectral fitting (AMARES) A magnetic resonance spectroscopy analysis technique based on time-domain data fitting

Aliasing Ambiguity resulting in an erroneous representation of the signal. Results from inadequate sampling, e.g., the fastest velocities appear in the reverse channel when all the flow is forward. In MRI, due to tissue outside the field of view

Anisotropy Anisotropy is the property of being directionally dependent, as opposed to isotropy, which means homogeneity in all directions

Apparent diffusion coefficient (ADC) An MRI parameter related to water diffusion properties. To obtain pure diffusion information a diffusion map can be calculated by combining at least two diffusion-weighted images that are differently sensitized to diffusion but remain identical with respect to the other parameters, spin density, T1, T2, TR, and TE. A parametric image containing these data is called an apparent diffusion coefficient (ADC) map

Attenuation Loss of energy from the ultrasound beam (leading to heating of tissue) during its passage

Axial resolution The ability to separate two targets at different depths along the axis of the beam

Bilirubin-induced neuronal dysfunction (BIND)

Blood oxygen level dependent (BOLD) Contrast mechanism based on blood oxygenation level frequently employed in functional MRI experiments

Cavitation The production and subsequent oscillation and collapse of bubbles in tissues subjected to high-intensity ultrasound

Cerebral metabolic rate (CMR)

Chemical shift imaging (CSI) In MRI a method for separately imaging water or fat: in MRS a multi-voxel localization technique

Chemical shift selective (CHESS) An MRS RF pulse sequence often used for water suppression

Choline (Cho) Commonly observed by MRS: includes membrane-related metabolites

Congenital heart disease (CHD)

Continuous wave (CW) Type of Doppler study in which ultrasound is transmitted and received continuously (in contrast to pulsed wave)

Creatine (Cr) Commonly observed by MRS: often co-existing with phosphocreatine in living tissue.

Demodulation Computerized process whereby frequency information is extracted from complex multifrequency signals – used in Doppler

Diffuse excessive high signal intensity (DEHSI) Qualitative MRI finding on T2-weighted images: abnormally high signal intensity in white matter seen frequently in ex preterm infants at term-equivalent age

Diffusion-weighted imaging (DWI) MRI method demonstrating changes in tissue water transport; useful for demonstrating cerebral damage very early after an injury

Doppler effect A change in frequency of an ultrasound pulse reflected from moving tissue (e.g., fast flowing blood)

Duplex system The combination of range-gated Doppler velocity measurement with real-time imaging

Echo The portion of an ultrasound pulse that is reflected at a boundary and subsequently detected by the transducer

Echo time (TE) In an MRI or MRS spin-echo study the total time from excitation pulse to the echo

Exponential decay time constant of the observed FID (T2*) Effective time constant for MRI magnetization decay in the plane orthogonal to B0 including local magnetic-field inhomogeneity effects: always ≤ T2

Extracorporeal membrane oxygenation (ECMO) An advanced intensive care technique available in very few centers, which involves oxygenation of the baby’s blood outside the body

Fourier transform A mathematical technique which analyzes the different frequencies present in a signal

Fractional anisotropy (FA) Fractional anisotropy is calculated from the eigenvalues λ1, λ2, λ3 of the diffusion tensor:

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λ is the mean diffusivity (trace/3); and λ1, λ2, λ3 diffusion tensor eigenvalues. FA is between 0 (perfect isotropic diffusion) and 1 (the hypothetical infinite cylinder – unidirectional) and subject intercomparable

Fraunhofer zone A region of an ultrasound beam furthest from a transducer where the beam becomes too broad to be useful for imaging

Free induction decay (FID) The exponentially decaying MRI RF signal from the flipped nuclear magnetization

Frequency Number of times per second that a change occurs; refers to the transducer vibration in ultrasound and precession rate of nuclear magnetization in MRI

Fresnel zone A region of an ultrasound beam nearest a transducer where the beam is narrowest and most useful for imaging

Germinal matrix–intraventricular hemorrhage (GMH-IVH) Bleeding that is isolated to the germinal matrix or associated with uncomplicated intraventricular hemorrhage – where there is blood in the ventricular cavity but no ventriculomegaly. This terminology clearly separates GMH-IVH from parenchymal lesions

Half-Fourier acquisition single shot turbo spin echo (HASTE) Very fast MRI technique based on the acquisition of a whole image following a single excitation. Often used when the organ of interest is subject to motion

Hypoplastic left heart syndrome (HLHS)

International Commission on Non-ionizing Radiation Protection (ICNIRP) International organization assessing risks and producing safety guidelines relevant to MRI

International Electrotechnical Commission (IEC) International body assessing risks and producing safety guidelines relevant to MRI

Inorganic phosphate (Pi) The orthophosphate in biological tissues: exists as the rapidly exchanging species HPO42− and H2PO4

Intensity A measure of the strength of an ultrasound beam, equal to the energy (joules) traveling through the tissue per second per square meter of area (or watts per square meter)

Intracellular pH (pHi) Estimable via MRS using many metabolite resonances (Pi often used)

Inversion recovery (IR) MRI technique providing T1 contrast

Larmor frequency The frequency of precession of the nuclear magnetic vector about the static magnetic field; in other words the resonance frequency (in Hz) of a peak

Lateral resolution The ability to distinguish between two closely spaced objects located at the same depth

Lenticulostriate vasculopathy (LSV)

Linear array An ultrasound probe consisting of a large number (up to 300) of small transducers arranged in a row

Line density Number of scan lines per unit distance or degree of arc

Longitudinal or spin-lattice relaxation time constant (T1) Time constant for MRI magnetization recovery parallel to B0

Magnetic resonance angiography (MRA) MRI technique imaging the vascular system

Magnetic resonance imaging (MRI) Imaging modality using magnetic and RF fields and obtaining contrast via tissue-water characteristics

Magnetic resonance spectroscopy (MRS) Informs about tissue metabolite composition and other biophysical attributes including pH

Magnetic resonance spectroscopy imaging (MRSi) Multi-voxel MRS localization method

Magnetization transfer (MT) MRI method relying on transfer of nuclear magnetization to adjacent, otherwise unimaged, molecules

Medicines and Healthcare Products Regulatory Agency (MHRA) United Kingdom government-sponsored body providing MRI safety guidance

N-Acetyl aspartate (Naa) A predominantly neuronal metabolite

National Radiological Protection Board (NRPB) United Kingdom government-sponsored body providing MRI safety guidance

Net sample magnetization (M0) The magnetization induced in a tissue sample by B0 and utilized by MRI and MRS

Nuclear magnetic resonance (NMR) The phenomenon of a resonance signal detectable from certain isotopes when in a strong magnetic field

Number of phase encoding steps (Npe) An MRI and MRSi parameter that is linked to spatial resolution in one of the dimensions

Noise An unwanted signal contaminating the signal of interest, which is usually random and will have a variety of causes

N-Methyl-D-aspartate (NMDA) An amino acid derivative that mimics the action of the neurotransmitter glutamate on NMDA receptors

Nucleotide triphosphate (NTP) Gives three prominent signals in phosphorus brain MRS: mainly attributable to ATP

Nyquist limit The maximum measurable Doppler shift frequency, equal to half the pulse repetition frequency

Outer volume suppressed image related in vivo spectroscopy (OSIRIS) MRS localization method: often used for phosphorus MRS


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