Optimal Timing of Spinal Ultrasound Evaluations for Sacral Dimples in Neonates: Earlier May Not Be Better.

OBJECTIVES: A spinal ultrasound (US) evaluation during the immediate postnatal period may have limited ability in evaluating filum thickness because of the spinal cord pulsation caused by a crowded subarachnoid space and the cerebrospinal fluid deficiency during this period. This study aimed to determine the optimal timing of spinal US to evaluate sacral dimples in neonates. METHODS: This study included 585 neonates who had a clinically suspicious sacral dimple and underwent spinal US examinations between January 2015 and August 2017. Patients were classified into 1 of 2 groups based on whether measurements of all parameters were possible (group A) or not (group B). Neonatal and maternal clinical factors, including the antenatal history and US parameters, were compared between groups. RESULTS: Group A included 443 patients, and group B included 82. Patients in group B were significantly younger (6.2 versus 31.0 days), had a younger corrective age (38.9 versus 42.5 weeks), and had a smaller body weight (3.1 versus 4.6 kg) than those in group A (all P < .005). However, no statistically significant differences were found in other patient or maternal factors (P > .05 for all). The pulsation of the conus medullaris and nerve roots of the cauda equina (14.6% versus 100%), thickening and echogenicity of the filum terminale (2.4% versus 100%), and the presence of a normal subarachnoid space (18.3% versus 100%) were significantly more difficult to detect in group B than in group A (all P < .001). CONCLUSIONS: For an accurate evaluation, which can reduce unnecessary confusion and costs, spinal US can be delayed until neonates grow beyond 31 days, with a corrected age of older than 42.5 weeks and body weight of greater than 4.6 kg.

Developmental Abnormalities of the Pediatric Spine: A Review of the Correlation Between Ultrasound and MRI Findings.

A broad spectrum of spinal pathologies can affect the pediatric population. Ultrasound (US) is the primary modality for pediatric spine assessment due to its widespread availability, non-requirement of sedation, and absence of ionizing radiation. Supplementing this, MRI offers an in-depth exploration of these conditions, aiding in preoperative strategizing. In this review, we examine the clinical indications, methodologies, and protocols for US and MRI scans of the pediatric spine. Additionally, we illustrate normal pediatric spinal anatomy, highlighting several examples of normal variants that are often misinterpreted. Through a series of case-based illustrations, we offer a comprehensive overview of various pathological conditions such as tethered cord, spinal dysraphism, spinal lipoma, diastematomyelia, and dermal sinus tract, among others. Furthermore, we explore the correlation between US and MRI findings for these lesions, employing real-world cases to enhance our understanding of this topic.

Cutaneous Stigmata of the Spine: A Review of Indications for Imaging and Referral.

Cutaneous stigmata of the midline spine are a common question in pediatrics. They are known to be related to a higher likelihood of underlying dysraphic spinal abnormalities. Clear understanding of different types of cutaneous stigmata and correlating dysraphic findings can aid in appropriate imaging workup and timely management of patient pathology. In this article, the authors review midline spinal cutaneous findings in the pediatric population with occult spinal dysraphism.

Spinal cord anomalies in children with anorectal malformations: Ultrasound is a good screening test.

PURPOSE: The purpose of this study is to correlate spinal ultrasound (US) and magnetic resonance imaging (MRI) findings in patients with anorectal malformations (ARMs). METHODS: A retrospective analysis of records was performed for children with ARM presenting to two major pediatric hospitals between 2009 and 2017. The primary outcome analyzed was detection of spinal cord anomalies. Spinal US was performed up to 4 months and MRI within the first year of life. The conus medullaris was considered normal if it had a tapering contour and terminated at or above the Lumbar 2-3 disk space. RESULTS: One hundred ninety-three patients with ARM presented during the study period with a slight male preponderance (108, 56%). Spinal imaging was performed in 157(82%) - 137(87%) had US, 64(41%) had MRI and 44 (28%) had both. Of the 44 who had both; US was abnormal in 25 children-confirmed by MRI in 20 (80%). US was normal in 17 children- MRI showed a filum cyst in 1 and a lipoma in 2 children and was inconclusive in 2 children (p<0.001). All who required surgery except one child, were reported on spinal US to have a low lying cord, borderline low cord or tethered cord (p<.05). No child who was reported to have a normal spinal US required de-tethering at a later stage. Spinal US had an overall sensitivity of 91% and specificity of 75% compared to MRI for detecting spinal cord anomalies in children with ARM CONCLUSIONS: Spinal US performed in a tertiary pediatric imaging department was a good screening test for spinal cord anomalies in children with ARM. The finding of a low, borderline low or tethered cord on US mandates an MRI to confirm the findings and correlates with the need for operative correction of spinal cord tethering. STUDY TYPE: Clinical research paper. LEVEL OF EVIDENCE: 2.

Joint registration of ultrasound, CT and a shape+pose statistical model of the lumbar spine for guiding anesthesia.

PURPOSE: Facet joint injections and epidural needle insertions are widely used for spine anesthesia. Accurate needle placement is important for effective therapy delivery and avoiding complications arising from damage of soft tissue and nerves. Needle guidance is usually performed by fluoroscopy or palpation, resulting in radiation exposure and multiple needle re-insertions. Several ultrasound (US)-based approaches have been proposed but have not found wide acceptance in clinical routine. This is mainly due to difficulties in interpretation of the complex spinal anatomy in US, which leads to clinicians' lack of confidence in relying only on information derived from US for needle guidance. METHODS: We introduce a multimodal joint registration technique that takes advantage of easy-to-interpret preprocedure computed topography (CT) scans of the lumbar spine to concurrently register a shape+pose model to the intraprocedure 3D US. Common shape coefficients are assumed between two modalities, while pose coefficients are specific to each modality. RESULTS: The joint method was evaluated on patient data consisting of ten pairs of US and CT scans of the lumbar spine. It was successfully applied in all cases and yielded an RMS shape error of 2.1 mm compared to the CT ground truth. The joint registration technique was compared to a previously proposed method of statistical model to US registration Rasoulian et al. (Information processing in computer-assisted interventions. Springer, Berlin, pp 51-60, 2013). The joint framework improved registration accuracy to US in 7 out of 17 visible vertebrae, belonging to four patients. In the remaining cases, the two methods were equally accurate. CONCLUSION: The joint registration allows visualization and augmentation of important anatomy in both the US and CT domain and improves the registration accuracy in both modalities. Observing the patient-specific model in the CT domain allows the clinicians to assess the local registration accuracy qualitatively, which is likely to increase their confidence in using the US model for deriving needle guidance decisions.

Ultrasound investigation of sacral dimples and other stigmata of spinal dysraphism.

OBJECTIVE: To assess whether there was any relationship between the number of clinical markers for spinal dysraphism and its presence on ultrasound and whether there was any relationship between the presence of an isolated sacral dimple and the presence of spinal dysraphism. Outcomes and further imaging were also examined. METHODS: All patients who underwent spinal ultrasound (SUS) in University Hospital Galway (UHG) over a 5-year period (2006-2011) were identified. Patients were excluded based on age (>14 years old excluded) and indication for imaging (only patients being investigated for suspected spinal dysraphism were included). Indications for imaging, ultrasound results and information on further imaging were accessed from the computerised radiology software in UHG. Statistical analysis was performed using SPSS-18. RESULTS: Data were analysed for 216 patients. A single clinical indication was recorded for 174 ultrasound requests, ≥2 indications for 42 requests. Nineteen of 216 (8.8%) ultrasound images were abnormal, 7 having spinal dysraphism. Multiple clinical indications were 6 times more likely to have dysraphism than those imaged on the basis of a single marker (OR 6.0, 95% CI 1.289 to 27.922, p=0.022), and there was no significant correlation between the presence of a sacral dimple and the presence of dysraphism (95% CI 0.71 to 6.622, p=0.722). CONCLUSIONS: SUS performed on the basis of multiple clinical indications is six times more likely to detect spinal dysraphism than imaging performed for isolated abnormalities or risk factors. Sacral dimple is a poor marker for occult spinal pathology.

Application of Spinal Ultrasound in Children with Congenital Anomalies of Spine / 中国康复理论与实践

@#ObjectiveTo assess the value of spinal ultrasound in children with congenital anomalies of spine. MethodsUltrasound findings of 36 children with congenital anomalies of spine were analyzed and compared with the finding of corresponding MRI or operation. ResultsUltrasound finding was the same as MRI in the anatomy in 31/36 children, in addition, it also could show the pulsatile motion and blood flow signals of conus medullaris. ConclusionSpinal ultrasound can present more other informations for diagnosis for congenital anomalies of spine, especially the blood supply of conus medullaris.