Philippe Manzoni MD, Abstract Co-Author: Nothing to Disclose

Adrian Imre Kastler, Abstract Co-Author: Nothing to Disclose

Sandrine Chapuy, Abstract Co-Author: Nothing to Disclose

Françoise Cattin MD, Abstract Co-Author: Nothing to Disclose

Sebastien Aubry MD, PhD, Abstract Co-Author: Nothing to Disclose

Bruno Alfred Kastler MD, PhD, Presenter: Nothing to Disclose

Clelia Billon Grand, Abstract Co-Author: Nothing to Disclose

Alessandra Biondi, Abstract Co-Author: Nothing to Disclose

MRI is to date the best imaging modality in the early depiction of multiple types of neuropathologic lesions in newborns. Indeed, it offers excellent soft-tissue contrast and good spatial resolution and it is a noninvasive and nonionizing technique. Literature comparing the usefulness of US and MR examinations of the neonatal brain suggest that US is not as effective a modality as MR. However, in emergency settings, US remains better than MR regarding access and availability as it is a real-time bed side imaging modality. In order to improve US sensitivity and due to delayed MRI access, transfontanellar contrast-enhanced ultrasound (TCEUS) was performed as first line examination and compared to MRI in brain injury diagnosis in neonates.

Five new borns were assessed during the neonatal period with TCEUS and brain MRI. Accuracy of the imaging findings were analyzed and compared. Three of these neonates presented with hypoxic-ischemic encephalopathy (HIE) symptoms, one suffered from severe epileptic seizures and an other presented with post esophageal atresia repair neurological impairment. All TCEU were realized under close neonatal intensive care supervision. Two separate injections of contrast material were systematically realized, subsequent arterial, venous and delayed phase US imaging were analyzed. The following MRI protocol was used : axial DWI,T1,T2, T2∗ and 3D TOF AngioMR.

In all 5 patients, a good correlation between TCEU and MRI was found. In neonates with HIE (3 cases), TCEUS and DWI sequences showed concordant impaired territories : hypovascularization on TCEUS versus hyperintensity on MRI (see figure 1). In the patient with post surgical neurological impairment, both MRI and TCEU showed intraventricular hemorrhage associated with subdural hematoma, but no ischemic lesions were seen. Finally, no abnormalities were detected in the patient with severe epileptic impairment on both imaging modalities.

TCEUS appears as a potential alternative and accessible imaging modality in the assessment of emergency neonatal brain injury. These promising preliminary results have to be confirmed by a larger prospective series of patients.

MRI is to date the goldstandard in neonatal brain imaging assessement. TCEUS appears to be a promising, accessible and new imaging modality in the emergency setting.

Manzoni, P, Kastler, A, Chapuy, S, Cattin, F, Aubry, S, Kastler, B, Billon Grand, C, Biondi, A, Transfontanellar Contrast-enhanced Ultrasound in Newborns: Preliminary Results in 5 Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015751.html