| Objective:To evaluate the ultrasound diagnosis of neonatal brain subependymal hemorrhage (SHE) and, by using color Doppler flow imaging ( CDFI) and pulsed wave Doppler ( PW), to detect the value of hemodynamic changes in newborns with intracranial hemorrhage.Methods:1 By using Philips M2540 A, an ultrasonic diagnostic apparatus, and by applying C8-5 neonatal brain-specific frequency of 5-8MHZ probe into fontanelle, early-stage SHE were found in 25 newborns, 15 with unilateral SHE, 10 with bilateral SHE.2 A total of 35 bleeding lesions, and the corresponding 35 vascular cerebral artery (ACA) blood flow dynamic indices were examined. Coronal scanning showed the ultrasound images of the frontal lobe: the probe was put as close to the forehead as possible, and meanwhile, it displayed the brain before the middle of crack, the frontal lobe and bilateral symmetrical cerebral hemisphere white matter distribution. The standard frontal section frontal lobe was taken as measurement section. ACA position was made clear by color Doppler: the angle between ACA and the probe was adjusted at 0°~ 15°so that the selected blood vessels of the section showed the central part of ACA to gather data, including systolic peak velocity (SV), diastolic peak velocity (DV), systolic and diastolic blood flow velocity ratio (S/D), resistance index (RI), pulsatility index (PI).3 Same procedures were applied to the control group of 25 newborns without intracranial hemorrhage. And a total of 50 indices were collected about the anterior cerebral artery hemodynamics4 The total of 35 bleeding lesions, and the corresponding 35 vascular cerebral artery (ACA) blood flow dynamic indexes were compared with those of the control group.5 Anterior cerebral artery blood flow velocity indices of the involved and uninvolved sides of 15 newborns with unilateral SHE were compared.6 Ultrasonic observation was applied to the 25 newborns with early-stage SHE at an interval of 12-24 hours. Bleeding lesions observations included the changes in size and those in internal echo.7 The newborns received timely and proper clinical treatment, including intensive care, bleeding stopping, restoring brain function, neural growth hormone and other drugs.8 When bleeding was completely absorbed, the two-dimensional ultrasound imaging showed no hemorrhage echo area and a table full thin envelope, anterior cerebral artery blood flow velocity indices of the involved and uninvolved sides of 15 newborns with unilateral SHE were remeasured and recompared.9 When the 25 newborns were in stable condition, CT or MRI testing was applied to confirm the diagnosis.Results:1 The lateral coronal plane of bleeding was detected below the anterior horn and body of the caudate nucleus head area echogenic area of block; its sagittal plane below the caudate nucleus in the thalamus oval groove-shaped, triangular or spindle-shaped echogenic area of block, not invading the lateral ventricle (Image 1), with minimum diameter of 2mm and maximum lesion of 18×15mm. Because part of a larger lesion pressed forefoot and body, the ventricles display was not clear.2 Vascular cerebral artery (ACA) blood flow dynamic indices of the two groups showed the systolic blood flow velocity of the 25 newborns was 22.87±6.67cm/s, higher than that of the control group(11.8±3.31cm/s), which is statistically significant(p<0.001); the diastolic blood flow velocity of the first group was 8.29±2.21cm/s, higher than that of the control group (4.42±1.68cm/s), which is statistically significant(p<0.001). The differences between the other indices(S/D, RI, PI) of the two groups are not statistically significant (P> 0.05).3 The ipsilateral and contralateral ACA hemodynamic indices of the 15 newborns with unilateral SHE showed the ipsilateral systolic blood flow velocity was 22.9±6.44cm/s, higher than that of the normal side(19.0±4.5cm/s), which is statistically significant (p<0.001); the ipsilateral diastolic blood flow velocity (8.08±2.14cm/s) was higher than that of the normal side (5.60±1.99cm/s), which is statistically significant (p<0.001). The differences between the other indices(S/D, RI, PI) of the two groups ares not statistically significant (P> 0.05) .4 When bleeding was completely absorbed in the 15 newborns with unilateral SHE, the original ipsilateral and contralateral ACA hemodynamic indices showed the ipsilateral systolic blood flow velocity was 14.9±2.56cm/s, higher than that of the normal side(15.2±2.27cm/s), no significant difference between the two(p=0.28); the ipsilateral diastolic blood flow velocity (5.89±1.34cm/s) was higher than that of the normal side (5.77±1.40cm/s). The difference is not statistically significant (p=0.3). The differences between the other indices(S/D, RI, PI) of the two groups are not statistically significant (P> 0.05)5 After bleeding 2-3 days, the contraction of blood clots appeared in all lesions. Bleeding lesions measured narrow. Two-dimensional ultrasonography indicated that the original echos and boundaries of bleeding lesions became stronger and clearer. 6-11 days after the bleeding lesions gradually reduced and absorbed, irregular hypoechoic or no-echo small cysts appeared in central hyperechoic mass; after 12-20 days, bleeding lesions eventually formed cysts.6 CT testing confirmed SHE in 22 cases, but failed to confirm the diagnosis in the other 3 patients,with hemorrhage diameters of 2mm, 2.5mm, 3mm respectively. With 3D mode or 3mm thin blood of MRI scanning, however, clear diagnosis of SHE was also confirmed in the 3 cases. Conclusion:Ultrasound diagnosis of neonatal subependymal hemorrhage can early detect bleeding in newborn infants. Early detection of ACA hemodynamic changes can screen high-risk infants in order that preventive measures can be taken and timely clinical attention given. Even for those infants suffering from intracranial bleeding, it is of clinical value with regard to planning ,treatment, prognosis, and late-phase therapy. |
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