We thank the nurses (appearing on film) for supporting the neonates. 
We thank J. Hagoort, MA, linguist, Department of Pediatric Surgery, Erasmus MC-Sophia Children&#8217;s Hospital, Rotterdam, the Netherlands, for reading and correcting the manuscript.

NOT: Bu protokol yerel insan araştırma etik komitesi kuralları izler. 1. Genel Hususlar NOT: teçhizat, veri depolama ve güvenlik ile ilgili genel hususlar Tartışma ele alınmaktadır. <ol><li> Frekanslarda (Tartışma) bir bant ile birden dönüştürücüler ile yüksek-çözünürlüklü, gerçek zamanlı, mobil 2D ultrason makinesi kullanarak görüntüleri edinin. Tipik haliyle, 7,5-8,5 MHz frekansında bir sonda kullanılarak iyi kalitede görüntüler elde edilir. </li></ol> CUS Sınav 2. Hazırlık <ol><li> Böyle kan örneklemesi gibi diğer prosedürler ile örtüşmemektedir böylece CUS muayene programlayın. </li><li> Böyle Yenidoğan Bireyselleştirilmiş Gelişimsel Bakım ve Değerlendirme Programı 6 esaslarına göre bu gibi stratejileri kullanarak, muayene sırasında yenidoğan bir sağlık çalışanı veya bir ebeveyn desteklemek için kullanılabilir olduğundan emin olun ve / veya konfor &lt;/ Sup&gt;. </li></ol> Ön Fontanel sayesinde 3. Sınav <ol><li> Inkübatör veya karyolası boyunca ultrason makinesi takın. </li><li> Prob ve deri arasında iyi bir temas sağlamak için sondaya dönüştürücü jel uygulanır. Kullanmadan önce jel ısınma düşünün. </li><li> B-modda bir konveks prob ile ön fontanel yoluyla görüntüleme başlatın. Yenidoğanın sağ tarafına döndü prob üzerine işaretleyici ile fontanel ortasında probu yerleştirin. Beynin sol tarafı, sonra monitörün sağ tarafında görüntülenir. Not: Fontanel aracılığıyla görüntüleme herhangi bir pozisyonda 3 içinde yeni doğmuş ile yapılabilir. Araştırma amaçlı standart bir baş pozisyonu için çaba gerekebilir. <ol><li> En az koronal beş ve beş sagital planlarda Kayıt görüntüleri. İlk görüntüde kranial hatlarını içeren, sektörün dolum bir görüntü üretmek için derinlik, kazanç ve kazanç zaman tazminat ayarlarını önlemekçok parlak veya karanlık görüntüler ing ve yakın ve derin yapılardan yansımalar arasında bir denge hedefliyor. </li><li> Koronal uçaklar NOT: mükemmel simetrik görüntüler elde etmeye çalışın. Frontal lob konveksite yakın lezyonlar şüpheli zaman bir yarımküre daha detaylı (Şekil 1) görüntülenir, böylece, belirli eğik koronal bölümleri kayıt düşünün. <ol><li> Koronal prefrontal görüntü için, açı prob ileri koku sulkuslar düzeyinde, lateral ventriküllerin frontal boynuzları anterior frontal lobları görselleştirmek için. </li><li> Monro düzeyinde, açı lateral ventriküller, cavum septi pellucidi, korpus kallosum, sulcus cingulinin ön boynuzları tasvir tela choroidea koronal bölümü anterior görselleştirmek için prob ile koronal görüntü için. Bazal ganglionlar parçaları ekojenisitesini unutmayın. </li><li> Talamus düzeyinde koronal görüntü için, açı prob geriye geç tanımlamak içinral çatlaklar, üçüncü ventrikül ve temporal lob çatı tela choroidea. Bazal ganglionlar ilgili talamus (özellikle ventrolateral çekirdekler) ekojenisitesini unutmayın. Pulvinar bu ağ hasarı sadece kulakçık önünde ek bir koronal bölümünde görüntülenmiştir tabi olabilir. </li><li> Kulakçıklar düzeyinde koronal görüntü için, koroid pleksus düzeyinde yanal ventrikülleri görselleştirmek. Temporal ve serebellar hemisferlerin belirleyin. Koroid pleksus göre periventriküler beyaz cevher ekojenisitesini unutmayın. Prematüre bebeklerde kulakçıklar yukarıda ve yanal, normal hiperekojen alanlar ile optik radyasyon karşılaştırın. </li><li> Koronal Paryetooksipital görüntü için, Paryetooksipital sulkusun seviyesine prob geriye açı parietal ve oksipital loblar tanımlamak için. </li></ol></li><li> Sagital uçaklar <ol><li> Yenidoğan yüzüne dönük prob üzerindeki işaretleyici ile sonda 90 ° döndürün. ThBeynin e ön kısmı monitörün sol tarafında görüntülenir. Aşağıdaki yapılardan seviyesinde kayıt görüntü (Şekil 2). </li><li> Midsagittal görüntü için, korpus kallosum, cavum septi pellucidi (CSP), üçüncü ve dördüncü ventrikül, vermis, sisterna magna, pons ve mesencephalon görselleştirmek. 7 interpositi Cavum Vergae varlığı ve Cavum veli edin. </li><li> Bir gangliothalamic oval aracılığıyla parasagital görüntünün (örneğin, sağ) için, lateral ventrikül içinden bir Parasagital görünüm için prob yana açısı. Koroid pleksus belirleyin ve talamus ve bazal ganglionlar ekojenisitesini not. Parasagital uçakları için taranan yan uygun metin araçları ile belirtilmelidir. </li><li> Insula ile Parasagital ada görüntü, açı sonda ayrıca yanal için. Yanal fissür ve verir ön, temporal-, parietal- ve oksipital lob belirleyin. </li><li> T tekrarlayın Parasagital görüntüleriO karşı tarafı (yani, sol). </li></ol></li><li> Renkli Doppler <ol><li> Renkli Doppler kullanarak konveks prob ile ön fontanel yoluyla görüntüleme devam edin. Serebral arter ve venlerin akış hızlarını değerlendirerek ve türetilmiş endeksleri elde düşünün. NOT: - diyastol sonu hız / pik sistolik hız Dirençli indeksi (RI) zirve sistolik hızı olarak tanımlanır. RI açı bağımsız, mutlak hız değerleri 8-10 değildir. RI farklı çaptaki arterlerde benzer değildir. Aynı kabın aynı yerde yapılan, seri ölçümler sadece yararlıdır. </li></ol></li><li> Aşağıdaki gemiler (Şekil 3) koronal düzlemlerde Kayıt görüntüleri: <ol><li> Beyincik düzeyinde enine sinüsleri gözünüzde canlandırın. Sadece bir ya da hiçbiri enine sinüsler görüntülenmiştir ise, darbe tekrarlama frekansı (PRF) düşürücü deneyin. Hala sadece bir veya enine sinüslerin hiçbiri daha sonra iseön fontanel ile tespit edilebilir, mastoid fontanel ile görselleştirme için yüksek frekanslı lineer prob kullanın (bölüm 4.4.2 bakınız). </li><li> Internal karotid arterlerin, orta serebral arterler ile Willis çemberi görselleştirmek ve lateral ventriküllerin frontal boynuzları düzeyinde serebral arterler anterior. Sol ve sağ ön serebral arterleri ayırt genellikle zordur, ama genellikle gereksizdir. Arterlerin striyatal Candelabra belirleyin. </li><li> Açı probu geriye komşu boyun damarları ile baziler arter görselleştirmek için. </li><li> Daha geriye Açı iç serebral ve thalamostriate damarları görselleştirmek için. </li></ol></li><li> Bir anterior serebral arter (Şekil 4) sagittal düzlemde bir görüntü kaydetmek. (Genellikle korpus kallosum genu altında) bu geminin belirli bir kısmında akış hızı ve RI değerlendirin. Yakın internal serebral ven orta hat hızları olabilirHemen ölçülebilen. </li><li> Ön fontanel bir koronal düzlemde bir yüksek frekanslı lineer prob kullanarak, üstün sagital sinüs tespit. Bu başarısız olursa, fontanel prob ile uygulanan basınç miktarını azaltır. NOT: Doğrusal prob yüzeysel yapıların (meninkslerin, araknoid ve subdural, korteks) ayrıntılı görüntülenmesi için kullanılabilir. Teğet gemiler subaraknoid vardır. İdeal olarak, daha önceki adımlarda açıklandığı gibi Doppler görüntüleme yeni doğanın ilk CUS inceleme sırasında gerçekleştirilir. Takip muayenesi sırasında bazı adımlar atlanabilir. Şüphelenilen beyin sinovenöz tromboz Doppler durumda, kademe 3.3.5.1, 3.3.7 ve 4.4.2 yapılmalıdır hazırlanır. </li></ol></li></ol> Alternatif Akustik, Windows sayesinde 4. Sınav <ol><li> Sonraki alternatif akustik pencerelerden incelenmesine devam. </li><li> (Pos lambdoid ile görüntü kaydederken düşününposterior) dışbükey prob (Şekil 5) kullanarak bıngıldak. Posterior fontanel sagital ve lambdoid sütür 3,11 kavşağında yer almaktadır. Lateral dekübit pozisyonunda yenidoğan koyarak arka fontanel aracılığıyla Görüntü. NOT: tatmin edici görüntüler de yatar pozisyonda 3 bebek ile sagital sütür arka yönü ile elde edilebilir birçok prematüre bebeklerde. <ol><li> Sagittal görünüm için arka fontanel ortasında probu yerleştirin. Açı biraz orta hatta kapalı prob lateral ventrikül gövdesi ve oksipital korna tanımlamak için. Koronal görünümü elde etmek için prob yaklaşık 90 ° çevirin. Lateral ventriküllerin oksipital boynuzları belirleyin. </li></ol></li><li> (Şekil 6) kulağın üzerinde bir dışbükey veya lineer prob kullanılarak yanal (zamansal) pencereden görüntüleri kaydederken düşünün. <ol><li> Gerekirse, bir izin yanal pencereden görüntü eldebeyin sapı 12 ayrıntılı görünümü. Kulağın önünde yatay yukarıda ve biraz probu yerleştirin. Serebral pedinküller görüntülenmiştir kadar probu hareket ettirin. NOT: Diğer yapılar tespit edilebilir üçüncü ventrikül, su kemeri ve temporal lob vardır. Renkli Doppler kullanarak, Willis çemberi görüntülenebilir. </li></ol></li><li> Mastoid fontanel ile rekor görüntüleri (Şekil 7). Mastoid bıngıldak zamansal, parietal ve oksipital kemikler 4 kavşağında, kulağın arkasında yer alır. Lateral dekübit pozisyonunda 3 yenidoğan koyarak mastoid fontanel aracılığıyla Görüntü. NOT: mastoid fontanel aracılığıyla görüntüler elde edilir bizim tecrübelerimize göre, yenidoğan sık sık rahatsızlık belirtileri gösterir. Bu nedenle, bu fontanel ve diğer akustik pencerelerden görüntüleme sonra bunu iyi olurdu. Biz bu rahatsızlık pulslere işitsel tepki mekanizması neden olabilir varsayımındaRadyofrekans enerjisinin 13 es. <ol><li> Dışbükey prob kullanarak mastoid fontanel aracılığıyla Görüntü. Koronal görünümü elde etmek için kulak prob paralel yerleştirin. Serebellar hemisfer, vermis, üçüncü ve dördüncü ventrikül, pons ve sisterna magna tanımlamak için ileri ve geri probu Sweep. Küçük prematüre karşı serebellar hemisfer iyi tasvir edilebilir. </li><li> Lineer prob kullanılarak mastoid fontanel aracılığıyla Görüntü. (Biri) enine sinüsler ön fontanel ile tespit edilemiyorsa, mastoid fontanel ile görselleştirme için yüksek frekanslı lineer prob kullanın. Koronal görünümü elde etmek için Kulak memesi prob paralel yerleştirin. <ol><li> Serebellar yarımkürede ve dördüncü ventrikül belirleyin. Renkli Doppler kullanarak, enine ve sigmoid sinüs, sinüs tentoryal ve elçisi damarları tespit. </li></ol></li></ol></li><li> Foramen magnum 14 ile posterior fossa ek görselleştirme düşünün. </li></ol>

<ol>
	<li>Plaisier, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+routine+early+MRI+in+preterm+infants.">Safety of routine early MRI in preterm infants.</a> Pediatric Radiology. 42 (10), 1205-1211 (2012).</li><li>Raets, M. M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Serial+Cranial+US+for+Detection+of+Cerebral+Sinovenous+Thrombosis+in+Preterm+Infants.">Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants.</a> Radiology. 269 (3), 879-886 (2013).</li><li>Di Salvo, D. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+view+of+the+neonatal+brain:+Clinical+utility+of+supplemental+neurologic+US+imaging+windows.">A new view of the neonatal brain: Clinical utility of supplemental neurologic US imaging windows.</a> Radiographics. 21 (4), 943-955 (2001).</li><li>Enriquez, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mastoid+fontanelle+approach+for+sonographic+imaging+of+the+neonatal+brain.">Mastoid fontanelle approach for sonographic imaging of the neonatal brain.</a> Pediatric Radiology. 36 (6), 532-540 (2006).</li><li>Luna, J. A., Goldstein, R. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+visualization+of+neonatal+posterior+fossa+abnormalities+through+the+posterolateral+fontanelle.">Sonographic visualization of neonatal posterior fossa abnormalities through the posterolateral fontanelle.</a> AJR Am J Roentgenol. 174 (2), 561-567 (2000).</li><li>Als, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individualized+Behavioral+and+Environmental+Care+for+the+Very-Low-Birth-Weight+Preterm+Infant+at+High-Risk+for+Bronchopulmonary+Dysplasia+-+Neonatal+Intensive-Care+Unit+and+Developmental+Outcome.">Individualized Behavioral and Environmental Care for the Very-Low-Birth-Weight Preterm Infant at High-Risk for Bronchopulmonary Dysplasia - Neonatal Intensive-Care Unit and Developmental Outcome.</a> Pediatrics. 78 (6), 1123-1132 (1986).</li><li>Govaert, P., de Vries, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> An Atlas of Neonatal Brain Sonography. , (2010).</li><li>Gray, P. H., Griffin, E. A., Drumm, J. E., Fitzgerald, D. E., Duignan, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+Wave+Doppler+Ultrasound+in+Evaluation+of+Cerebral+Blood-Flow+in+Neonates.">Continuous Wave Doppler Ultrasound in Evaluation of Cerebral Blood-Flow in Neonates.</a> Archives of Disease in Childhood. 58 (9), 677-681 (1983).</li><li>Seibert, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Duplex+Pulsed+Doppler+Ultrasonography+Versus+Intracranial-Pressure+in+the+Neonate+-+Clinical+and+Experimental+Studies.">Duplex Pulsed Doppler Ultrasonography Versus Intracranial-Pressure in the Neonate - Clinical and Experimental Studies.</a> Radiology. 171 (1), 155-159 (1989).</li><li>Volpe, J. J., Perlman, J. M., Hill, A., Mcmenamin, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+Blood-Flow+Velocity+in+the+Human+Newborn+-+the+Value+of+Its+Determination.">Cerebral Blood-Flow Velocity in the Human Newborn - the Value of Its Determination.</a> Pediatrics. 70 (1), 147-152 (1982).</li><li>Correa, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Posterior+fontanelle+sonography:+An+acoustic+window+into+the+neonatal+brain.">Posterior fontanelle sonography: An acoustic window into the neonatal brain.</a> American Journal of Neuroradiology. 25 (7), 1274-1282 (2004).</li><li>Helmke, K., Winkler, P., Kock, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+examination+of+the+brain+stem+area+in+infants.+An+echographic+and+anatomic+analysis.">Sonographic examination of the brain stem area in infants. An echographic and anatomic analysis.</a> Pediatric Radiology. 17 (1), 1-6 (1987).</li><li>Elder, J. A., Chou, C. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Auditory+response+to+pulsed+radiofrequency+energy.">Auditory response to pulsed radiofrequency energy.</a> Bioelectromagnetics. , S162-S173 (2003).</li><li>Brennan, C. M., Taylor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+imaging+of+the+posterior+fossa+utilizing+the+foramen+magnum.">Sonographic imaging of the posterior fossa utilizing the foramen magnum.</a> Pediatric Radiology. 40 (8), 1411-1416 (2010).</li><li>Rutherford, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging+of+white+matter+diseases+of+prematurity.">Magnetic resonance imaging of white matter diseases of prematurity.</a> Neuroradiology. 52 (6), 505-521 (2010).</li><li>Wezel-Meijler, G., Steggerda, S. J., Leijser, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cranial+Ultrasonography+in+Neonates:+Role+and+Limitations.">Cranial Ultrasonography in Neonates: Role and Limitations.</a> Seminars in Perinatology. 34 (1), 28-38 (2010).</li><li>Leijser, L. M., de Vries, L. S., Cowan, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+cerebral+ultrasound+effectively+in+the+newborn+infant.">Using cerebral ultrasound effectively in the newborn infant.</a> Early Human Development. 82 (12), 827-835 (2006).</li><li>Houston, L. E., Odibo, A. O., Macones, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+safety+of+obstetrical+ultrasound:+a+review.">The safety of obstetrical ultrasound: a review.</a> Prenatal Diagnosis. 29 (13), 1204-1212 (2009).</li><li>Torloni, M. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+ultrasonography+in+pregnancy:+WHO+systematic+review+of+the+literature+and+meta-analysis.">Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis.</a> Ultrasound in Obstetrics &amp; Gynecology. 33 (5), 599-608 (2009).</li></ol>

The authors have nothing to disclose.

Biz açıklamak ve neonatal Doppler KUS için bir state-of-the-art yaklaşımı göstermektedir. Deneyimli ellerde, bu güvenli, seri başucu neonatal beyin görüntüleme için mükemmel bir araçtır. Birçok NICU&#39;lere açıklanan olanakları en iyi şekilde kullanılmaz. Doppler çalışmaları ekleme intrakranial arterlerin ve venlerin açıklığının taranması için izin verir. Akış hızları değerlendirildi ve endeksleri elde edilebilir. Doppler CUS inme 2 önce tedavi müdahaleye imkan, sinü...

Since its clinical introduction in the late 1970&#8217;s cranial ultrasound (CUS) has been widely used for detecting congenital anomalies and acquired brain lesions during the neonatal period. In many neonatal intensive care units (NICUs), CUS has become indispensable in the care for critically ill neonates. Major advantages are its relatively low cost and the fact that it can be performed at bedside, even when a patient is unstable. In addition it is radiation-free and allows for serial imaging. Another technique often used for neuroimaging in critically ill neonates is magnetic resonance imaging (MRI). MRI provides excellent image quality, but its clinical use in NICU&#8217;s is currently limited because of logistic and safety issues1. 
Over time, quality of CUS has drastically improved, with advancing technique leading to higher resolution, faster image processing and digital display and back-up. Important brain structures can be adequately visualized using optimal settings. Traditionally, images are obtained through the anterior fontanel. This approach is less suitable for evaluation of infratentorial structures because they are located far away from the transducer and the highly echoic tentorium impedes their assessment. Use of high-frequency linear transducers through alternative acoustic windows and adapted settings also provides access to these brain regions. Examples of these supplemental acoustic windows are the lambdoid (posterior), mastoid and lateral (temporal) fontanels. So far, however, only few NICUs use these additional acoustic windows routinely2-5. Doppler techniques can be used for screening patency of intracranial vessels. Flow velocities and indices in cerebral arteries can also be obtained. Some manufacturers now provide hardware to visualize flow around 2 cm/sec (Raets, et al., unpublished data). Small vessels are well displayed: medullary trunks and channels, subependymal veins tributing to the thalamostriate veins, and perforator arteries. 
We present our approach of neonatal CUS, focusing on the use of different transducers, multiple acoustic windows and Doppler techniques. Neonatologists and radiologists use this approach in daily clinical practice but is also suitable for research purposes. In the practical part of the video we demonstrate bedside use in the NICU.

<table border="0" cellpadding="0" cellspacing="0" width="693">
	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:191px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">MyLab 70</td>
			<td style="width:191px;">Esaote (Genoa, Italy)</td>
			<td style="width:119px;"></td>
			<td>Ultrasound system</td>
		</tr>
	</tbody>
</table>

state of the art cranial ultrasound imaging in neonates

Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed.

7 - tarif edilen protokole göre görüntüleme örnekleri, Şekil 1 &#39;de sunulmaktadır. Görüntüler dikkatlice deneyimli bir gözlemci tarafından yorumlanması gerekir. Simetrik görüntüleme Fontanel (Şekil 1) ile yapılan koronal görüntülerin yeterli yorumlanması için gereklidir. Herhangi bir şüpheli lezyon ön fontanel başka bir akustik pencereden hem koronal ve (orta) sagital düzlemde veya görselleştirme tarafından görüntülenmiştir edilmeli...

Watch this Scientific Journal Video about State of the Art Cranial Ultrasound Imaging in Neonates at JoVE.com

State of the Art Cranial Ultrasound Imaging in Neonates

Cranial ultrasound (CUS) is a valuable tool for brain imaging in critically ill neonates. This video shows a comprehensive approach for neonatal (Doppler) CUS for both clinical and research purposes, including a bedside demonstration of the technique.

Yenidoğan Sanat Kranial Ultrason Görüntüleme Devlet

Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a ...

state-of-the-art-cranial-ultrasound-imaging-in-neonates

Research

JoVE Journal

Medicine

23.9K Görüntüleme.  Erasmus MC-Sophia Children's Hospital. Cranial ultrasound (CUS) is a valuable tool for brain imaging in critically ill neonates. This video shows a comprehensive approach for neonatal (Doppler) CUS for both clinical and research purposes, including a bedside demonstration of the technique. 

Video: State of the Art Cranial Ultrasound Imaging in Neonates

Dual-mode Imaging of Cutaneous Tissue Oxygenation and Vascular Function

Accurate assessment of cutaneous tissue oxygenation and vascular function is important for appropriate detection, staging, and treatment of many health disorders such as chronic wounds. We report the development of a dual-mode imaging system for non-invasive and non-contact imaging of cutaneous tissue oxygenation and vascular function. The imaging system integrated an infrared camera, a CCD camera, a liquid crystal tunable filter and a high intensity fiber light source. A Labview interface was programmed for equipment control, synchronization, image acquisition, processing, and visualization. Multispectral images captured by the CCD camera were used to reconstruct the tissue oxygenation map. Dynamic thermographic images captured by the infrared camera were used to reconstruct the vascular function map. Cutaneous tissue oxygenation and vascular function images were co-registered through fiduciary markers. The performance characteristics of the dual-mode image system were tested in humans.

A dual-mode imaging system was developed for non-contact assessment of cutaneous tissue oxygenation and vascular function.

Kutanöz Doku oksijenasyon ve Damar Fonksiyon dual-mode Görüntüleme

Accurate assessment of cutaneous tissue oxygenation and vascular function is important for appropriate detection, staging, and treatment of many health ...

Tıp

Murine Echocardiography and Ultrasound Imaging

Rodent models of cardiac pathophysiology represent a valuable research tool to investigate mechanism of disease as well as test new therapeutics.1 Echocardiography provides a powerful, non-invasive tool to serially assess cardiac morphometry and function in a living animal.2 However, using this technique on mice poses unique challenges owing to the small size and rapid heart rate of these animals.3 Until recently, few ultrasound systems were capable of performing quality echocardiography on mice, and those generally lacked the image resolution and frame rate necessary to obtain truly quantitative measurements. Newly released systems such as the VisualSonics Vevo2100 provide new tools for researchers to carefully and non-invasively investigate cardiac function in mice. This system generates high resolution images and provides analysis capabilities similar to those used with human patients. Although color Doppler has been available for over 30 years in humans, this valuable technology has only recently been possible in rodent ultrasound.4,5 Color Doppler has broad applications for echocardiography, including the ability to quickly assess flow directionality in vessels and through valves, and to rapidly identify valve regurgitation. Strain analysis is a critical advance that is utilized to quantitatively measure regional myocardial function.6 This technique has the potential to detect changes in pathology, or resolution of pathology, earlier than conventional techniques. Coupled with the addition of three-dimensional image reconstruction, volumetric assessment of whole-organs is possible, including visualization and assessment of cardiac and vascular structures. Murine-compatible contrast imaging can also allow for volumetric measurements and tissue perfusion assessment.

This video demonstrates use of a rail-mounted high-frequency ultrasound probe to perform echocardiography on an anesthetized mouse. The methods describe both conventional two-dimensional and M-mode measurements of cardiac function in addition to newer, more powerful tools such as color Doppler, strain analysis, as well as general and targeted contrast imaging.

Murin Ekokardiyografi ve Ultrasonik Görüntüleme

Rodent models of cardiac pathophysiology represent a valuable research tool to investigate mechanism of disease as well as test new therapeutics.1  ...

MRI-guided Disruption of the Blood-brain Barrier using Transcranial Focused Ultrasound in a Rat Model

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a significant obstacle to pharmaceutical treatments of brain disorders as it limits the passage of molecules from the vasculature into the brain tissue to molecules less than approximately 500 Da in size6. FUS induced BBB disruption (BBBD) is temporary and reversible4 and has an advantage over chemical means of inducing BBBD by being highly localized. FUS induced BBBD provides a means for investigating the effects of a wide range of therapeutic agents on the brain, which would not otherwise be deliverable to the tissue in sufficient concentration. While a wide range of ultrasound parameters have proven successful at disrupting the BBB2,5,7, there are several critical steps in the experimental procedure to ensure successful disruption with accurate targeting. This protocol outlines how to achieve MRI-guided FUS induced BBBD in a rat model, with a focus on the critical animal preparation and microbubble handling steps of the experiment.

Microbubble-mediated focused ultrasound disruption of the blood-brain barrier (BBB) is a promising technique for non-invasive targeted drug delivery in the brain1-3. This protocol outlines the experimental procedure for MRI-guided transcranial BBB disruption in a rat model.

Sıçan Modelinde Transkraniyal Odaklanmış Ultrason kullanarak Kan-beyin bariyeri MRG eşliğinde bozulması

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

Manyetik Rezonans Görüntüleme, Volumetrik Bilgisayarlı Tomografi ve Ultrason Kullanımı Meme Kanseri Kemik metastazı bir Nude Rat Model Angiogenezis Multi-modal Görüntüleme

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

Imaging Glioma Initiation In Vivo Through a Polished and Reinforced Thin-skull Cranial Window

Glioma is the one of the most lethal forms of human cancer. The most effective glioma therapy to date-surgery followed by radiation treatment-offers patients only modest benefits, as most patients do not survive more than five years following diagnosis due to glioma relapse 1,2. The discovery of cancer stem cells in human brain tumors holds promise for having an enormous impact on the development of novel therapeutic strategies for glioma 3. Cancer stem cells are defined by their ability both to self-renew and to differentiate, and are thought to be the only cells in a tumor that have the capacity to initiate new tumors 4. Glioma relapse following radiation therapy is thought to arise from resistance of glioma stem cells (GSCs) to therapy 5-10. In vivo, GSCs are shown to reside in a perivascular niche that is important for maintaining their stem cell-like characteristics 11-14. Central to the organization of the GSC niche are vascular endothelial cells 12. Existing evidence suggests that GSCs and their interaction with the vascular endothelial cells are important for tumor development, and identify GSCs and their interaction with endothelial cells as important therapeutic targets for glioma. The presence of GSCs is determined experimentally by their capability to initiate new tumors upon orthotopic transplantation 15. This is typically achieved by injecting a specific number of GBM cells isolated from human tumors into the brains of severely immuno-deficient mice, or of mouse GBM cells into the brains of congenic host mice. Assays for tumor growth are then performed following sufficient time to allow GSCs among the injected GBM cells to give rise to new tumors-typically several weeks or months. Hence, existing assays do not allow examination of the important pathological process of tumor initiation from single GSCs in vivo. Consequently, essential insights into the specific roles of GSCs and their interaction with the vascular endothelial cells in the early stages of tumor initiation are lacking. Such insights are critical for developing novel therapeutic strategies for glioma, and will have great implications for preventing glioma relapse in patients. Here we have adapted the PoRTS cranial window procedure 16and in vivo two-photon microscopy to allow visualization of tumor initiation from injected GBM cells in the brain of a live mouse. Our technique will pave the way for future efforts to elucidate the key signaling mechanisms between GSCs and vascular endothelial cells during glioma initiation.

Imaging Glioma Initiation In Vivo Through a Polished and Reinforced Thin-skull Cranial Window

By combining a polished and reinforced thin-skull (PoRTS) cranial window and glioblastoma (GBM) cell injection, we can observe glioma initiation and growth from injected GBM cells in the brain of a live mouse longitudinally.

Görüntüleme Glioma Başlatma<em&gt; In Vivo</em&gt; Bir Parlak ve Takviyeli İnce kafatası Kranial Pencere arkası

Glioma is the one of the most lethal forms of human cancer. The most effective glioma therapy to date-surgery followed by radiation treatment-offers ...

A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.

We describe a new ultrasound-based vector tissue Doppler imaging technique to measure muscle contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities. This approach provides complementary measurements of dynamic muscle function and could lead to a better understanding of mechanisms underlying musculoskeletal disorders.

Kas-iskelet Ultrason Görüntüleme Bir Roman Uygulama

Ultrasound is an attractive modality for imaging muscle and tendon  motion during dynamic tasks and can provide a complementary methodological  approach ...

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves' Muntjac Deer

Reeves' muntjac deer (Muntiacus reevesi) are a small cervid species native to southeast Asia, and are currently being investigated as a potential model of prion disease transmission and pathogenesis. Vertical transmission is an area of interest among researchers studying infectious diseases, including prion disease, and these investigations require efficient methods for evaluating the effects of maternal infection on reproductive performance. Ultrasonographic examination is a well-established tool for diagnosing pregnancy and assessing fetal health in many animal species1-7, including several species of farmed cervids8-19, however this technique has not been described in Reeves' muntjac deer. Here we describe the application of transabdominal ultrasound to detect pregnancy in muntjac does and to evaluate fetal growth and development throughout the gestational period. Using this procedure, pregnant animals were identified as early as 35 days following doe-buck pairing and this was an effective means to safely monitor the pregnancy at regular intervals. Future goals of this work will include establishing normal fetal measurement references for estimation of gestational age, determining sensitivity and specificity of the technique for diagnosing pregnancy at various stages of gestation, and identifying variations in fetal growth and development under different experimental conditions.

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves&#039; Muntjac Deer

Transabdominal ultrasound is described as an effective, noninvasive means for assessing reproductive status in Reeves' muntjac deer. These methods can be used to achieve early pregnancy diagnosis and to evaluate fetal viability. Future applications of this technique include estimation of gestational age and effects of maternal disease on fetal development.

Reeves'in Muntjac Geyisinde Gebelik Tanısı için Transabdominal Ultrason

Reeves' muntjac deer (Muntiacus reevesi) are a small cervid species native to southeast Asia, and are currently being investigated as a potential model of ...

Diagnostic Ultrasound Imaging of Mouse Diaphragm Function

Function analysis of rodent respiratory skeletal muscles, particularly the diaphragm, is commonly performed by isolating muscle strips using invasive surgical procedures. Although this is an effective method of assessing in vitro diaphragm activity, it involves non-survival surgery. The application of non-invasive ultrasound imaging as an in vivo procedure is beneficial since it not only reduces the number of animals sacrificed, but is also suitable for monitoring disease progression in live mice. Thus, our ultrasound imaging method may likely assist in the development of novel therapies that alleviate muscle injury induced by various respiratory diseases. Particularly, in clinical diagnoses of obstructive lung diseases, ultrasound imaging has the potential to be used in conjunction with other standard tests to detect the early onset of diaphragm muscle fatigue. In the current protocol, we describe how to accurately evaluate diaphragm contractility in a mouse model using a diagnostic ultrasound imaging technique.

Diagnostic ultrasound imaging has proven to be effective in diagnosing various respiratory diseases in human and animal subjects. We demonstrate a comprehensive ultrasound protocol utilized by Dr. Zuo's lab to analyze diaphragm kinetics specifically in mouse models. This is also a non-invasive research technique which can provide quantitative information on mouse respiratory muscle function.

Fare Diyafram Fonksiyonu Diagnostik Ultrason Görüntüleme

Function analysis of rodent respiratory skeletal muscles, particularly the diaphragm, is commonly performed by isolating muscle strips using invasive ...

Transcutaneous Microcirculatory Imaging in Preterm Neonates

Microcirculatory imaging (MI) is a relatively new research tool mainly used in the intensive care setting. MI provides a clear view of the smallest capillaries, arterioles and venules. The magnifying effect visualizes the flow pattern of erythrocytes through these vessels.
It's non-invasive character makes it suitable to apply in (preterm) neonates, even in cardiorespiratory unstable patients. In adults and children, MI is mainly performed sublingually, but this is not possible in preterm infants as these cannot cooperate and the size of the probe is problematic. In preterm infants, MI is therefore performed transcutaneously. Their thin skin makes it possible to obtain high quality images of peripheral microcirculation. 
In this manuscript we will demonstrate the method of transcutaneous MI in preterm infants. We will focus on the different techniques and provide tips to optimize image quality. The highlights of software settings, safety and offline analysis are also addressed.

Microcirculatory imaging (MI) is used to monitor peripheral perfusion in critically ill or preterm neonates. This manuscript and video demonstrates the optimal approach for obtaining high-quality images.

Preterm Yenidoğan Transkutanöz Mikrosirkülasyonda Görüntüleme

Microcirculatory imaging (MI) is a relatively new research tool mainly used in the intensive care setting. MI provides a clear view of the smallest ...

Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been widely used to measure aortic dimensions in mouse models of aortic aneurysms. Aortic aneurysms are defined as permanent dilations of the aorta, which occur most frequently in the ascending and abdominal regions. Sequential measurements of aortic dimensions by ultrasound are the principal approach for assessing the development and progression of aortic aneurysms in vivo. Although many reported studies used ultrasound imaging to measure aortic diameters as a primary endpoint, there are confounding factors, such as probe position and cardiac cycle, that may impact the accuracy of data acquisition, analysis, and interpretation. The purpose of this protocol is to provide a practical guide on the use of ultrasound to measure the aortic diameter in a reliable and reproducible manner. This protocol introduces the preparation of mice and instruments, the acquisition of appropriate ultrasound images, and data analysis.

Ultrasound imaging has become a common modality to determine the luminal dimensions of thoracic and abdominal aortic aneurysms in mice. This protocol describes the procedure to acquire reliable and reproducible two-dimensional ultrasound images of the ascending and abdominal aorta in mice.

Torasik ve Abdominal aort anevrizması boyutlarını belirlemek farelerde ultrason görüntüleme

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been ...