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Spinal ultrasound in infants

Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK

View larger version (54K): [in a new window]   Figure 1. Normal sagittal neonatal spine on an extended field of view ultrasound. The L1 vertebral body is indicated. Note the position of the cord in an anteroposterior direction as well as the echogenic nerve roots extending beyond the tip of the conus medullaris. The spinal cord lies between short arrows. Hyperechoic central canal (long arrow). A, anterior; P, posterior; S, superior; I, inferior. (Reproduced with kind permission from Dick EA, de Bruyn R, Patel K, Owens CM. Spinal ultrasound in cloacal exstrophy. Clin Radiol 2001;56:289–94.

View larger version (74K): [in a new window]   Figure 2. Sagittal spinal ultrasound showing tethering of the cord with dorsal displacement. The conus medullaris lies at the level of L5 (long arrow). Cutaneous sacral dimple is seen (short arrow).

View larger version (75K): [in a new window]   Figure 3. (a) Normal axial neonatal spine at the level of T12 showing the dentate ligaments extending laterally from the spinal cord (arrow). (b) Normal axial neonatal spine at the level of L3 showing echogenic nerve roots. Left-sided nerve roots arrowed.

View larger version (121K): [in a new window]   Figure 4. Sagittal spinal ultrasound showing a low cord but no tethering. The tip of the conus lies at thelower level of L2 but the cord is not dorsally displaced.

View larger version (122K): [in a new window]   Figure 5. Axial spinal ultrasound showing diastematomyelia. Both hemicords are arrowed. An echogenic spur lies between the two hemicords.

View larger version (112K): [in a new window]   Figure 6. (a) Plain radiograph showing partial absence of the right sacrum and coccyx (arrow) in a patient with an anterior meningocele. (b) Sagittal spinal ultrasound (same patient) demonstrates an anechoic unilocular meningocele anterior to the sacrum (long arrow), anterior to the inferior portion of the sacrum (short arrow). (c)Sagittal T1 weighted MRI (same patient) demonstrates a low signal meningocele (arrow) anterior to the inferior portion of the sacrum.

View larger version (105K): [in a new window]   Figure 7. (a) Sagittal spinal ultrasound showing lipoma of the filum terminale (arrow). (b) Sagittal T1 weighted MRI (same patient) demonstrates high signal lipoma (arrow). (c) Sagittal T2 weighted MRI (same patient) demonstrates lipoma of intermediate signal, and confirms that the cord is tethered, extending to level L5. (d)Sagittal line diagram showing features of lipoma of the filum terminale. The lipoma (L) tethers a low lying spinal cord (large arrow). The intradural lipoma is separated from subcutaneous fat of the back by a tissue plane (small arrows). (e) Sagittal line diagram showing features of lipomyelomeningocele in the lumbosacral region. There is a large dysraphic defect in the neural arches and a skin-covered herniated sac composed of fat that is contiguous with the subcutaneous fat (asterisks) and a low lying tethered spinal cord (arrows). ((a–c) reproduced with kind permission from Dick EA, de Bruyn R, Patel K, Owens CM. Spinal ultrasound in cloacal exstrophy. Clin Radiol 2001;56:289–94. (d,e) reproduced with kind permission from Byrd SE, Darling CF, McLone DG, Tomita T. MR imaging of the pediatric spine. Magn Reson Imaging Clin N Am 1996;4:797–833.)

View larger version (71K): [in a new window]   Figure 8. (a) Sagittal spinal ultrasound (SUS) showing anechoic myelomeningocele in continuity with both a tethered cord (the conus lies at L5) and a cutaneous soft tissue mass. (b) Axial SUS (same patient) showing anechoic myelomeningocele in continuity with tethered cord. (c) Sagittal line diagram showing features of a myelomeningocele. Note the large dysraphic defect in the neural arches, the herniated sac of exposed neural tissue posteriorly (arrows) and cerebrospinal fluid (CSF) anteriorly. ((a,b) reproduced with kind permission from Dick EA, de Bruyn R, Patel K, Owens CM. Spinal ultrasound in cloacal exstrophy. Clin Radiol 2001;56:289–94. (c) reproduced with kind permission from Byrd SE, Darling CF, McLone DG, Tomita T. MR imaging of the pediatric spine. Magn Reson Imaging Clin N Am 1996;4:797–833.