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Sonography of the Neonatal Spine: Part 1, Normal Anatomy, Imaging Pitfalls, and Variations That May Simulate Disorders

¹ Department of Radiology, The University of Missouri-Kansas City, Kansas City, MO.
² Department of Radiology, Children's Mercy Hospital and Clinics, 2401 Gillham Rd., Kansas City, MO 64108.
³ Department of Radiology, St. Luke's Hospital, Kansas City, MO.

View larger version (21K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Schematics illustrate three stages of spinal cord development. Neurulation (closure of neural tube) is process of progression from neural plate to neural groove to neural tube. (Reprinted with permission from Sadler T. Langman's medical embryology, 5th ed. Baltimore, MD: Lippincott Williams & Wilkins, 1985:335 [5])

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Schematics illustrate three stages of spinal cord development. Canalization occurs when multiple microcysts form and coalesce in caudal cell mass (arrows), which fuses to distal neural tube (arrowheads), forming primitive spinal cord. (Reprinted with permission from Barkovich AJ. Normal development of the neonatal and infant brain, skull and spine. In: Barkovich AJ. Pediatric neuroimaging, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2000:624 [2])

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Schematics illustrate three stages of spinal cord development. Retrogressive differentiation (programmed cell death) is process whereby caudal cell mass and neural tube regress in size to form fetal conus medullaris, ventriculus terminalis, and filum terminale. Note labeled structures. (Reprinted with permission from Barkovich AJ. Normal development of the neonatal and infant brain, skull and spine. In: Barkovich AJ. Pediatric neuroimaging, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2000:624 [2])

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —1-week-old boy with normal lumbar spine sonogram and history of unilateral renal agenesis. Transverse lumbar sonogram shows normal anatomy as labeled. V = vertebra, transverse process (arrowhead).

View larger version (47K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —1-week-old boy with normal lumbar spine sonogram and history of unilateral renal agenesis. Longitudinal lumbar sonogram shows normal anatomy as labeled. Note central echoic complex (arrowheads), a normal finding that results from interface of central end of anterior median fissure and not central spinal canal.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —1-month-old boy with ventriculus terminalis who was referred for deep sacral dimple and who is developmentally normal at 18 months. Longitudinal sonogram of spine reveals distention of distal lumbar spinal canal just above conus medullaris (arrowhead). Size smaller than 5 mm and stability over time distinguish this normal variant from small syrinx.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —1-month-old boy with ventriculus terminalis who was referred for deep sacral dimple and who is developmentally normal at 18 months. Sagittal T2-weighted MR image at age 7 months shows stable distention of distal spinal canal (arrowhead), excluding syrinx.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Filar cyst in 14-day-old girl with deep sacral dimple and normal motor development. Transverse sonogram of proximal cauda equina shows well-defined, midline, cystic collection (arrow). Note normal ventral and dorsal nerve root bundles (arrowheads).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Filar cyst in 14-day-old girl with deep sacral dimple and normal motor development. Longitudinal sonogram reveals well-defined fusiform "cyst" in midline (arrow) just below conus medullaris. Also note prominent echogenic central spinal canal (arrowhead), a normal variant seen in some children.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Filar cyst in 5-week-old boy with multiple anomalies who had been followed up with MRI at age 2 months. Longitudinal sonogram of filum and cauda equina (arrowhead) shows unusually long filar cyst (calipers). Despite its length, it meets criteria for filar cyst: location just below conus medullaris, fusiform shape, well defined, thin walled, and hypoechoic.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Filar cyst in 5-week-old boy with multiple anomalies who had been followed up with MRI at age 2 months. Longitudinal T2-weighted MR image shows ill-defined filar cyst (arrows) that is better seen on sonography.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Prominent filum terminale in 2-week-old boy with asymmetric gluteal crease. Longitudinal sonogram shows hyperechoic filum of normal size (< 1 mm) (arrow) at L5-S1.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Positional pseudomass in 2-week-old boy with left renal agenesis who was scanned in left decubitus position. Transverse sonogram shows clumping of nerve roots (arrows) on left due to left decubitus position.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Positional pseudomass in 2-week-old boy with left renal agenesis who was scanned in left decubitus position. Longitudinal sonogram also reveals masslike appearance of nerve roots (arrows). Prone images (not shown) were normal.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —Pseudosinus tract in 12-day-old infant with dimple in gluteal crease. Longitudinal sonogram shows cartilaginous, hypoechoic, dorsally curving tip of coccyx (arrowhead), from which hypoechoic cordlike structure (curved arrow) extends caudally and terminates at base of skin dimple (straight arrow).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Misshapen coccyx in two neonatal girls, each with palpable "lump" beneath sacral dimple in gluteal crease. Longitudinal sonogram of coccyx in 2-week-old girl shows hypoechoic cartilaginous tip (arrowheads), which is acutely angulated dorsally as it extends toward skin surface. Palpated "lump" was tip of coccyx.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Misshapen coccyx in two neonatal girls, each with palpable "lump" beneath sacral dimple in gluteal crease. Longitudinal sonogram of coccyx in 2-week-old girl reveals it is straightened, with loss of its normal ventral curve. Hypoechoic cartilaginous tip (arrowhead) extends dorsally toward skin surface, causing clinically palpable "lump."

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