The Three-dimensional Volume Ultrasound In The Qualitative And Quantitative Diagnosis Of Neonatal Intracranial Hemorrhage

Research backgroundNeonatal intracranial hemorrhage in the neonatal period is the most common and important in diseases of the nervous system, a wide range of bleeding can cause serious consequences, especially for infants, is one of the important causes of neonatal and developmental disorders of the nervous system. So the early diagnosis of intracranial hemorrhage of the newborn is particularly important, not only to the diagnosis and treatment of clinicians to provide effective information, to fective and reasonable treatment, to lay the foundation for good prognosis, which can improve the cure rate, to reduce the sequela of the nervous system, plays a more important role. Therefore, in-depth study and understanding of these issues will be very beneficial to improve the treatment technology and the level of clinical.Ultrasound is a technique by using the properties of the sound wave ultrasound to understand a body structure an its corresponding patholo- gical process.B type ultrasound is a two-dimensional imaging to gray scale in the form of the screen real time display. In twentieth Century 70 end ultrasonic diagnosis technology applys in the field to start diagnosis of neonatal intracranial diseases, opens the ultrasonicits corresponding diagnostic chorizonsitscorrespondingwith further improving imaging technology. It can clearly display changes of ventricle, various lacuna structure and brain parenchyma. With the rapid development of computer technology in twentieth Century 80 and three dimensional ultrasound imaging technology, Nagdyman used three-dimensional ultrasound in neonatal cerebral anatomic structure for the first time since the 1999, opening up a new field of application of three dimensional ultrasound. 3D ultrasound accurately shows the relationship between the lesions and surrounding tissues of brain, displays the lesion size and volume measurement. Neonatal birth￠s fontanelle as acoustic window for good, can not only obtains the good imaging effect, but also provides very favourable conditions for our diagnosis of neonatal intracranial lesions. Cranial ultrasound examination can discover intracranial hemorrhage, and show the exact position of hemorrhage, and accurate understanding of the progression and severity of intracranial hemorrhage, especially for not moving, the rescuing of critically ill children, not leaving the warm box, such as neonatal ventilator neonatal not convenient for CT and MRI to check special instruments. CT needs to be moved and is radioactive, MRI is expensive, big noise,time-consuming, and not suitable for repeated review. CT and MRI slice thickness examination is often difficult to find the subependymal hemorrhage and intraventricular smaller group and other shortcomings.Ultrasonography has advantages of low price, no X-ray damage, no trauma, simple and fast, real-time, security, fast imaging speed, repeatable bedside examination and dynamically observed in children with the disease progress, so it can be widely used in neonatal intracranial hemorrhage and continuous dynamic monitoring of neonatal intracranial hemorrhage.Early diagnosis and treatment may reduce the left sequela and reduce neonatal mortality,so it is very important clinical guidance value. The qualitative and quantitative diagnosis of intracranial hemorrhage of newborn early can be more accurate, timely provision of scientific and effective for clinical diagnosis. But previous studies focused on the qualitative diagnosis of intracranial hematoma, researched the quantitative less,studied more rare relationship between quantitative analysis and prognosis in children. Objective(1) explore the value of ultrasound diagnosis of neonatal intracranial hemorrhage;(2) study the accuracy of intracranial hemorrhage quantity analysis of two dimensional ultrasonography quantitative;(3) explore the quantitative three-dimensional ultrasound analysis of the effect on the prognosis of children with analysis of the feasibility and accuracy, and bleeding quantity of intracranial hemorrhage MethodCases from the Maternal and Child Health Hospital of Tai’an city from January 2013 to December 2013 in the newborn Department of Pediatrics in our hospital, underwent both ultrasound and CT examination, diagnosis of neonatal intracranial hemorrhage in 200 cases, gestational age(26-41 weeks), age 0 ~ 31 d, average 8D, male 110 cases, female 90 cases, of which 80 cases preterm infants. The ultrasonic instrument for PHILS- excel, Philipsiu22 color ultrasonic diagnostic instrument, the frequency of 5~7.5MHz, small high-frequency convex array probe, sector scan. For the clinical suspicion of nervous system diseases or intracranial hemorrhage were treated by two-dimensional ultrasound through the anterior fontanelle coronary and sagittal scanning, to conduct a preliminary screening of intracranial structures, and at the same time the CT to confirm the diagnosis, screening intracranial hemorrhage cases, comparative study of different methods. Two dimensional ultrasound mainly observe intracranial midline brain, ventricles of the brain, choroid plexus and brain parenchyma echo intensity and structure, and semi quantitative evaluation on the amount of bleeding. The bleeding site of 3D data acquisition of three-dimensional volume using three-dimensional ultrasound probe, quantitative analysis of the amount of bleeding volume. And CT examination to detect intracranial hemorrhage, with CT quantitative analysis as the standard control volume of intracranial hemorrhage, the accuracy analysis of two-dimensional and three-dimensional ultrasound quantitative bleeding. All patients were followed up, to analyze the relationship between the sites of bleeding, amount of bleeding and clinical prognosis in children.Result1.Two-dimensional ultrasound can clearly tube membrane hemorrhage, intraventricular hemorrhage, a substantial part of cerebral hemorrhage and large subdural hemorrhage. The central part of the highest resolution brain hemorrhage. The small subdural hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage in the posterior cranial fossa and brain, at the edge of bleeding is difficult to diagnose. Ultrasonography for intracranial hemorrhage especially subependymal hemorrhage(SEH) and intraventricular hemorrhage(IVH) resolution is better than CT.2. There are mang methods in two dimensional ultrasound quantitative intracranial hemorrhage a.At present, 1 / 2abc and 1 / 3abc are the most widespread in the clinical application. In this study, 2 / 3Sh is calculated by formula. By using T test and correlation analysis results of 105 cases of data shown in equation 2 / 3Sh and CT computer aided volumetric analysis method(gold standard) calculation of intracranial hemorrhage has good correlation. Fig. 11 Bland_Altman analysis showed that 2 / 3Sh method for the determination of bleeding volume and the gold standard numerical estimation has good consistency3.Three-dimensional ultrasound has value more accurate determinations of the irregular volume.This study uses three-dimensional volume ultrasound measuring intracranial hemorrhage, results show that3 D ultrasound analysis content and CT computer aided the volume of intracranial hemorrhage(gold standard) calculation of intracranial hemorrhage has higher correlation and consistency. The intracranial hematoma in 105 cases data is used to estimate 3D volume method and the gold standard, Bland_Altman 2 analysis showed that the 3D method for the determination of bleeding volume and the gold standard estimation values are in good agreement.4. The study subjects were followed up, ventricle subependymal hemorrhage, hematoma and arachnoid subdural hemorrhage is rapidly absorbed, general 2 ~ 3 weeks basic completely absorbed; brain parenchyma mass hemorrhage, intraventricular hemorrhage absorbed slowly, generally in the treatment of 1 the left and right months hemorrhage began to absorb, the group only 2 cases of hemorrhage absorbed within 2 weeks of normal, most of the lesions were completely absorbed in 1 ~ 3 months.5.Clinical follow-up, ultrasound in the diagnosis of intracranial hemorrhage in 157 cases, grade I、grade II 93 cases without obvious clinical symptoms or neurological symptoms of light, the prognosis is good; 37 cases in grade Ⅲ, Ⅳ 26 cases showed neuropsychiatric symptoms in different degree, can leave sequela, the prognosis is poor, the need for nervous system intervention therapy. Subependymal hemorrhage 80 cases, bleeding volume of 0.03 ~ 1.15 ml, mainly located in the subependymal hemorrhage; intraventricular hemorrhage without ventricular dilatation in 13 cases, bleeding volume of 0.73 ~ 1.86 ml; simple ventricular dilatation in 14 cases, bleeding volume of 2.97 ~ 9.68 ml, 11 cases of hydrocephalus, the amount of bleeding was about 7.3ml to 15.8ml, 12 cases of ventricular cavity of cyst, hemorrhage was 8.2 ~ 17.4ml, hemorrhage in ventricles; encephalomalacia in 26 cases, bleeding volume of about 11.21 ~ 26.4 ml, mainly located around lateral ventricle hemorrhage and brain parenchyma. Subdural hemorrhage in 1 cases, bleeding was about 8.65 ml.The follow-up of 145 cases of intracranial hemorrhage in children according to the prognosis of the patients will be divided into five groups:without sequelae, mild sequelae, moderate, severe sequelae sequelae.No sequela group 87 cases, mainly for Ⅰ, Ⅱ hemorrhage; subdural hemorrhage; 15 cases of mild sequelae, mainly for grade II, a small amount of grade Ⅲ hemorrhage; moderate sequelae in 27 cases, mainly for grade III, IV, 16 cases of severe sequelae, mainly for IV and intracerebral hemorrhage. Conclusion1. Ultrasound has no radiation damage, safe, cheap, convenient, non-invasive, for bedside examination and dynamic observation and other advantages, especially for infants, can be used as the preferred imaging routine screening and follow-up diagnosis method.2. Compared with the two-dimensional ultrasound,three-dimensional ultrasonography can reflect the spatial relationship between shape and the surrounding brain tissue of intracranial hemorrhage, bleeding the quantitative accuracy is higher than that of two-dimensional ultrasound method.3. The neonatal intracranial hemorrhage early in qualitative and quantitative diagnosis is great clinical value for prognosis judgment of neonatal intracranial hemorrhage.