1
|
Kagan KO, Tost F, Heling KS, Hoopmann M, Sonek J, Chaoui R. Fetal eye ultrasound: Normal anatomy, abnormal findings, and clinical impact. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38848751 DOI: 10.1055/a-2318-5464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Until now, ultrasound examination of the fetal eyes has not played an important role in prenatal diagnosis. National and international guidelines are generally confined to documentation of the presence of the orbits and the lenses. However, in recent years, with the advent of high-resolution ultrasound technology and increasing knowledge of prenatal medicine and genetics, careful examination of the fetal eye has enabled the detection of many ocular malformations before birth. This article provides an overview of the anatomy related to the development of the fetal eye and covers the following conditions: hypertelorism, hypotelorism, exophthalmos, microphthalmos, coloboma, cataract, persistent hyperplastic primary vitreous, retinal detachment, dacryocystocele, and septooptic dysplasia, etc. It is designed to illustrate the spectrum of ocular malformations and their appearance on prenatal ultrasound and to discuss their clinical impact and association with various syndromes.
Collapse
Affiliation(s)
- Karl-Oliver Kagan
- Prenatal Medicine, University Hospital Tübingen, Department of Women's Health, Tübingen, Germany
| | - Frank Tost
- Department of Ophthalmology, University Medicine Greifswald, Germany
| | - Kai-Sven Heling
- Medical practice, Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Markus Hoopmann
- Prenatal Medicine, University Hospital Tübingen, Department of Women's Health, Tübingen, Germany
| | - Jiri Sonek
- Division of Maternal Fetal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, United States
- Fetal Medicine Foundation USA, Dayton, United States
| | - Rabih Chaoui
- Medical Practice, Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| |
Collapse
|
2
|
Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics (Basel) 2023; 13:diagnostics13030535. [PMID: 36766639 PMCID: PMC9914511 DOI: 10.3390/diagnostics13030535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.
Collapse
|
3
|
Yildizdas D, Aslan N. Is Ocular Sonography a Reliable Method for the Assessment of Elevated Intracranial Pressure in Children? J Pediatr Intensive Care 2021; 10:14-22. [PMID: 33585057 DOI: 10.1055/s-0040-1716385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 10/23/2022] Open
Abstract
Point-of-care ultrasound has been widely used by clinicians at the bedside in recent years. Various types of point-of-care ultrasound practices are employed, especially in pediatric emergency rooms and intensive care units. Pediatric intensive care specialists perform point-of-care ultrasound virtually as a part of physical examination since it provides just-in-time vital clinical information, which could assist in acute management strategies in critically ill patients. Measurement of optic nerve sheath diameter using point-of-care ultrasound is a noninvasive and radiation-free technique to determine raised intracranial pressure. Ophthalmic artery and central retinal artery Doppler indices can be used as transcranial Doppler to assess raised intracranial pressure. The aim of this review was to provide detailed information on ultrasonographic measurements of optic nerve sheath diameter and central retinal artery Doppler indices as techniques of interest for predicting increased intracranial pressure in pediatric patients in view of the literature.
Collapse
Affiliation(s)
- Dincer Yildizdas
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nagehan Aslan
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| |
Collapse
|
4
|
Yapicioglu H, Aslan N, Sertdemir Y, Yildizdas D, Gulasi S, Mert K. Determination of normal values of optic nerve sheath diameter in newborns with bedside ultrasonography. Early Hum Dev 2020; 145:104986. [PMID: 32335478 DOI: 10.1016/j.earlhumdev.2020.104986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/07/2019] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bedside sonographic opthalmic ultrasound measurement of optic nerve sheath diameter (ONSD) is an easy, portabl, noninvasive and a radiation free technique to determine increased intracranial pressure. This prospective, multicenter study was aimed to establish the range of normal values for ONSD in preterm and term newborns with a large study population. METHODS Newborns without intracranial pathology in the Newborn Intensive Care Units and in Obstetrics and Gynecology Departments were enrolled in the study. ONSD was measured at 3 mm distance behind of the right optic nerve head. As 3 mm distance was beyond the optic nerve head in some of the premature newborns, we had also measurements at 2 and 2.5 mm. RESULTS ONSD was measured in 554 newborns. Mean ONSD of preterm babies at 2, 2.5 and 3 mm distances were 3.2 ± 0.3 mm (range 2.0-4.2 mm), 3.3 ± 0.3 mm (range 2.2-4.5 mm) and 3.6 ± 0.2 mm (range 2.9-4.5 mm), (p2.0-2.5 mm < 0.001, p 2.5-3.0mm < 0.001, p2.0-3.0 mm < 0.001) respectively. Mean ONSD of term babies at 3 mm was higher than the mean ONSD of preterm babies in 33 weeks 0 day- 37 weeks 0 days group (p < 0.001). In correlation analysis, a significant, strong and positive correlation was found between ONSD measurements and gestational age, weight, height and head circumference at 2, 2.5 and 3 mm distances. CONCLUSION The normal values reported by the present study may be used for evaluating the ONSD of newborns with different conditions with increased incracranial pressure.
Collapse
Affiliation(s)
- Hacer Yapicioglu
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Turkey
| | - Nagehan Aslan
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Turkey.
| | - Yasar Sertdemir
- Cukurova University, Faculty of Medicine, Department of Biostatistics, Turkey
| | - Dincer Yildizdas
- Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Turkey
| | - Selvi Gulasi
- Adana City Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Adana, Turkey
| | - Kurthan Mert
- Adana City Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Adana, Turkey
| |
Collapse
|
5
|
Ardell S, Daspal S, Holt T, Hansen G. Optic Nerve Sheath Diameter for Preterm Infants: A Pilot Study. Neonatology 2019; 116:1-5. [PMID: 30889584 DOI: 10.1159/000497163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In preterm infants, early diagnosis and management of a raised intracranial pressure (ICP) may be important to improve neurodevelopmental outcomes. While invasive ICP monitoring is not recommended, ultrasonography of the optic nerve sheath diameter (ONSD) could provide a noninvasive alternative to evaluate ICP. The objective of this pilot study was to document ranges of ONSD in preterm infants. METHODS This prospective cohort pilot evaluated preterm infants who were admitted to the neonatal intensive care unit without suspected raised ICP. Three images per eye were obtained from a 20-5 MHz linear array ultrasound transducer placed on the patient's superior eyelid. The OSND was measured 3 mm behind the globe. A second ultrasonographer duplicated half of the scans. Multiple linear regression analysis was conducted for both right and left ONSD with corrected gestational age, weight, and head circumference as predictors. Lin's concordance assessed interrater reliability. RESULTS In 12 preterm infants 114 scans were performed on both eyes. The median age was 33 weeks (corrected gestational age) with a range of 29-36 weeks. Corrected gestational age was the strongest predictor for ONSD, and preliminary measurements at each gestational age were established. Interrater reliability demonstrated substantial agreement (Qc = 0.97). CONCLUSION In preterm infants, ONSD strongly correlates with corrected gestational age. These data should be validated with other imaging modalities before abnormal ranges can be considered.
Collapse
Affiliation(s)
- Sarah Ardell
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sibasis Daspal
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tanya Holt
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gregory Hansen
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada,
| |
Collapse
|
6
|
Al-Haddad CE, Sebaaly MG, Tutunji RN, Mehanna CJ, Saaybi SR, Khamis AM, Hourani RG. Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations. AJNR Am J Neuroradiol 2018; 39:369-374. [PMID: 29217740 DOI: 10.3174/ajnr.a5456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few articles in the literature have looked at the diameter of the optic nerve on MR imaging, especially in children, in whom observations are subjective and no normative data exist. The aim of this study was to establish a data base for optic nerve diameter measurements on MR imaging in the pediatric population. MATERIALS AND METHODS This was a retrospective study on the MR imaging of pediatric subjects (younger than 18 years of age) at the Department of Diagnostic Radiology at the American University of Beirut Medical Center, Beirut, Lebanon. The optic nerve measurements were obtained by 3 raters on axial and coronal sections at 3 mm (retrobulbar) and 7 mm (intraorbital) posterior to the lamina cribrosa. RESULTS Of 211 scans of patients (422 optic nerves), 377 optic nerves were measured and included. Ninety-four patients were female (45%) and the median age at MR imaging was 8.6 years (interquartile range, 3.9-13.3 years). Optic nerves were divided into 5 age groups: 0-6 months (n = 18), 6 months-2 years (n = 44), 2-6 years (n = 86), 6-12 years (n = 120), and 12-18 years (n = 109). An increase in optic nerve diameter was observed with age, especially in the first 2 years of life. Measurements did not differ with eye laterality or sex. CONCLUSIONS We report normative values of optic nerve diameter measured on MR imaging in children from birth to 18 years of age. A rapid increase in optic nerve diameter was demonstrated during the first 2 years of life, followed by a slower increase. This was independent of sex or eye laterality.
Collapse
Affiliation(s)
- C E Al-Haddad
- From the Departments of Ophthalmology (C.E.A.-H., C.J.M.)
| | - M G Sebaaly
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - R N Tutunji
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - C J Mehanna
- From the Departments of Ophthalmology (C.E.A.-H., C.J.M.)
| | - S R Saaybi
- Pediatrics (S.R.S.), American University of Beirut Medical Center, Beirut, Lebanon
| | - A M Khamis
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - R G Hourani
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| |
Collapse
|
7
|
Szmygel Ł, Kosiak W, Zorena K, Myśliwiec M. Optic Nerve and Cerebral Edema in the Course of Diabetic Ketoacidosis. Curr Neuropharmacol 2017; 14:784-791. [PMID: 26915420 PMCID: PMC5333594 DOI: 10.2174/1570159x14666160225155151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/22/2022] Open
Abstract
In the recent years we have been observing an increased incidence of type 1 diabetes in children and adolescents. This leads to a more frequent acute complication of type 1 diabetes among children with hyperglycemia. The most common of these is diabetic ketoacidosis (DKA), while cerebral edema is the most dangerous. In children with DKA, cerebral edema most often presents with clinical symptoms but may also appear in the so-called "subclinical" form. That is why the search continues for new methods of assessing and monitoring cerebral edema in the course of DKA treatment. Ultrasonographic optic nerve sheath diameter (US ONSD) assessment is performed in various clinical scenarios when cerebral edema is suspected. It is most often performed in adult patients but increasingly often in children. US ONSD assessment is useful in the treatment of DKA in children with type 1 diabetes. This manuscript provides an overview of research results available in PubMed and other available databases on the course of treatment of DKA in children with type 1 diabetes.
Collapse
Affiliation(s)
- Łukasz Szmygel
- Clinic of Pediatrics Diabetology and Endocrinology, Medical University of Gdansk, 80-952 Gdansk, Poland
| | | | | | | |
Collapse
|
8
|
Optic Nerve Sheath Diameter Ultrasonography in Pediatric Patients with Diabetic Ketoacidosis. Can J Diabetes 2016; 40:126-30. [DOI: 10.1016/j.jcjd.2015.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022]
|
9
|
Ko SB. Optic Nerve Sheath Diameter on Brain Magnetic Resonance Imaging: A Single Center Study. JOURNAL OF NEUROCRITICAL CARE 2015. [DOI: 10.18700/jnc.2015.8.1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
10
|
Corral E, Stecher X, Malinger G, Ochoa JH, de Catte L, Sepulveda W. Thrombosis of the torcular herophili in the fetus: a series of eight cases. Prenat Diagn 2014; 34:1176-81. [DOI: 10.1002/pd.4453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/08/2014] [Accepted: 06/28/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Edgardo Corral
- Prenatal Ultrasound Unit, Department of Obstetrics and Gynecology, Regional Hospital; Diego Portales University; Rancagua Chile
- Fetal Medicine Center; Fetal Medicine Interest Group GIMEF; Santiago Chile
| | - Ximena Stecher
- Neuroradiology Unit, Department of Radiology; Barros-Luco Hospital; Santiago Chile
| | - Gustavo Malinger
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Jose H. Ochoa
- Diagnus, Prenatal Diagnosis Center; Cordoba Argentina
| | - Luc de Catte
- Department of Obstetrics and Gynecology; Fetal Medicine Unit, University Hospitals Leuven; Leuven Belgium
| | - Waldo Sepulveda
- Fetal Medicine Center; Fetal Medicine Interest Group GIMEF; Santiago Chile
| |
Collapse
|
11
|
Abstract
Fetal magnetic resonance imaging (MRI) is used with increasing frequency as a complementary imaging modality to ultrasound (US) in prenatal diagnosis. Fetal MRI displays the fetal, uterine, and extrauterine anatomy in ways that allow confirmation of normal anatomy and the diagnosis of pathological entities that were formerly very difficult to detect prenatally. Comparison of US views with standard orthogonal plane MR images reinforces the understanding of fetal anatomy as visualized with US. Technological advances in US equipment have allowed the recent description of subtle fetal anatomical structures. Similarly, knowledge of the MRI appearances of pathological conditions has opened opportunities for the sonographic diagnosis of entities such as brainstem malformations and alterations in the normal transient laminar pattern that occur during development of the fetal cerebrum. Fetal MRI can confirm suspicious US findings and thus add confidence in a particular prenatal diagnosis before performing invasive and interventional procedures. Specific MRI sequences can be used to add information about the chemical composition of fetal structures, such as fat, blood, and meconium. Dynamic MRI sequences have increased understanding of gestational age-dependent behavior, and assist the sonographer in assessment of fetal structural anomalies that cause abnormal movement and behavior. The technological ability of US to demonstrate very small structures complements the lower resolution of fetal MR images, whereas the ability of MR to visualize the whole fetus improves the limited views necessitated by US. Therefore, both US and fetal MRI have complementary strengths and weaknesses that can be used to full advantage in prenatal diagnosis.
Collapse
|
12
|
García-Arreza A, García-Díaz L, Fajardo M, Carreto P, Antiñolo G. Isolated absence of septum pellucidum: prenatal diagnosis and outcome. Fetal Diagn Ther 2012; 33:130-2. [PMID: 22572040 DOI: 10.1159/000338009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/07/2012] [Indexed: 11/19/2022]
Abstract
Septal agenesis is a rare cerebral developmental anomaly characterized by partial or complete absence of the septum pellucidum (ASP). Septal agenesis may be associated with various congenital brain malformations, namely holoprosencephaly, septooptic dysplasia (SOD), schizencephaly or agenesis of the corpus callosum. Current imaging technologies do not enable differentiation in utero between isolated ASP and SOD. This is due to the fact that optic nerve hypoplasia and endocrine anomalies are never ruled out completely. We report a case of prenatal diagnosis of isolated ASP based on 2D and 3D ultrasound and fetal MRI. Postnatal MRI confirmed prenatal findings and the boy is currently doing well at 18 months of age.
Collapse
Affiliation(s)
- Aida García-Arreza
- Unidad de Gestión Clínica de Genética, Reproducción y Medicina Fetal, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | | | | | | | | |
Collapse
|