Elsevier

Clinical Radiology

Volume 58, Issue 3, March 2003, Pages 227-233
Clinical Radiology

Evaluation of Spinal Ultrasound in Spinal Dysraphism

https://doi.org/10.1016/S0009-9260(02)00478-6Get rights and content

Abstract

AIMS: The aims of this study were to evaluate the role of spinal ultrasound in detecting occult spinal dysraphism (OSD) in neonates and infants, and to determine the degree of agreement between ultrasound and magnetic resonance imaging (MRI) findings.

MATERIALS AND METHODS: Eighty-five consecutive infants had spinal ultrasound over 31 months. Of these, 15 patients (age 1 day–7 months, mean 40 days; nine male) had follow-up MRI. Ultrasound and MRI findings were correlated retrospectively.

RESULTS: Six out of 15 (40%) ultrasound examinations showed full agreement with MRI, seven of 15 (47%) had partial agreement, and two of 15 (13%) had no agreement. In the present series ultrasound failed to visualize: four of four dorsal dermal sinuses, three of four fatty filum terminales, one of one terminal lipoma, two of four partial sacral agenesis, three of four hydromyelia and one of 10 low-lying cords.

CONCLUSION: Agreement between ultrasound and MRI was good, particularly for the detection of low-lying cord (90%). Therefore we recommend ultrasound as a first-line screening test for OSD. If ultrasound is abnormal, equivocal or technically limited, MRI is advised for full assessment.

Section snippets

Methods

Between July 1999 and February 2002 (31 months), 85 consecutive spinal ultrasound examinations were performed in the paediatric radiology department. Indications for spinal ultrasound in our practise included evaluation of a lumbosacral mass or cutaneous stigmata, abnormal spinal radiographs, known spinal dysraphism and previous repair of open spinal dysraphism. Seventy-four of 85 spinal ultrasound examinations were reported as normal, and 11 of 85 spinal ultrasound examinations were reported

Results

Three of 15 spinal MRIs were reported as normal, and 12 of 15 were reported to have congenital defects (Fig. 1, Fig. 2, Fig. 3, Fig. 4) of which 10 had multiple concurrent abnormalities. One infant, patient 12, was initially reported by the fellow in neuroradiology to have a dorsal dermal sinus ending at the coccyx, however, on review by a paediatric radiologist it was reported as a normal natal cleft impression. All other MRI reports remained unchanged. The degree of agreement between

Discussion

Spinal dysraphism is the second most common congenital abnormality after cardiac malformations, occurring in up to two per 1000 live births [19], although the incidence of open defects is probably decreasing in the U.K. with antenatal diagnosis. The remaining closed, skin-covered OSD lesions, however, may be missed on antenatal ultrasound. The importance in early diagnosis of OSD results from the association of cord tethering to the sacrum or meningeal/soft-tissues by the underlying lesion in

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