*7.2.2 Other imaging methods*

*Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications*

spinal canal with its content and surrounding soft tissues [17].

Ultrasonography is a safe and effective screening method that is commonly used in screening system of the newborns. It is noninvasive imaging method that does not require sedation of newborn without exposure to radiation [12]. Newborns with physiological finding on ultrasonography do not require any further imaging evaluation. On the other hand, positive finding on ultrasonography require more detailed

Ultrasonography is the first-line survey for the assessment of spinal cord abnormalities. During the first six months of life non-ossificated vertebral arches and cartilagineous posterior elements provide acoustic window for detained imaging of

Ultrasonography of the spinal cord in infants is very effective tool for imaging of spine and spinal cord compared to postossification [3, 12]. Major indication of spinal ultrasonography in selected group of newborns is possible detection of tethered cord syndrome. Progress of ossification in time makes ultrasonography

Indications for spinal ultrasonography in newborns are: cutaneous lesions on the back (such as hypertrichosis, subcuteaneous lipoma, sacral sinus, sacral dimple), spinal deformity, neurological abnormality (paraparesis, neurogenic bladder or bowel dysfunction), spinal trauma during delivery and syndromes with associated

Spinal ultrasonography is performed in infant in lying prone position with the upper body higher than lower and in flexed spine (curved over pillow). This position offers better acoustic window. Imaging is performed with linear transducer through longitudinal and axial plane scans from craniocervical junction to coccyx [3]. The main structures that must be identified are: conus medularis, filum terminale, cauda equina and spinal roots, central echo complex and subarachnoid spaces. Tip of conus medularis is in newborns usually located L1 and L2 interspace, occasionally on the level of superior end plate of L3. Filum terminale is a band of fibrous tissue that extends from the conus to the caudal end of spinal canal. At the level of L5 and S1 it should be less than 2 mm thick and should be predominantly hypoechoic with a bright hyperechoic periphery. Cauda equina and spinal roots must move according to the pulsatile production of cerebrospinal fluid, as the ultrasonography provides live image of the structures. Central echo-complex is train-line hyperechogenicity provided by the interface of the two margins of spinal canal. It needs to be detectable at all levels of spine and the space must be regular along entire extension. The subarachnoid space is anechoic and does not contain

In order to avoid unnecessary further imagings it is important to know some anatomical variations that are considered physiological. Some of them are: mild thickening of the epidural fat, mild thickening of the filum terminale (between 1 and 2 mm), malformation of the coccyx with palpable prominence in the sacral region, transient dilatation of the central canal (usually disappears during the

Also known as fifth ventricle. It refers to mild cystic dilatation of the terminal part of spinal cord canal due to incomplete regression of embryonic ventriculus

**7.2 Postnatal diagnostics**

*7.2.1 Ultrasonography*

more difficult [12].

compression of spinal cord [41].

structures except spinal cord and nerve roots [3].

*7.2.1.1 Persistence of ventriculus terminalis*

imaging performed by MR imaging [41].

**38**

first weeks).

As ultrasonography of the brain and spine is quick and good available it is the bet diagnostic first-line tool. But for proper imaging of brain, spine and supporting structures for evaluation of extent of the defect, treatment planning and estimation of prognosis there is a need for use of other diagnostic methods. After detailed ultrasonography newborns with more severe spinal defects undergo MR imaging of spine. In open spinal defects with a risk of hydrocephalus newborns undergo CT or MR imaging of the brain according to clinical need with a detection of serious neuroimaging findings, such as ventriculomegally, tonsilar descent, hind brain abnormalities, nodular heterotopia of gray matter and corpus callosum abnormalities – such as aplasia, hypoplasia/partial aplasia with or without dysplasia [23].
