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Evaluation of spinal ultrasound in spinal dysraphism
J A Hughes1, R De Bruyn, K Patel
1Great Ormond Street Hospital for Children, London, UK. jaqhughes@hotmail.com
Insights
Spinal ultrasound shows good agreement with MRI for detecting occult spinal dysraphism (OSD) in infants. Ultrasound is recommended as a first-line screening tool for OSD, with MRI for further assessment if needed.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Neonatal Screening
Background:
- Occult spinal dysraphism (OSD) requires accurate diagnostic methods in neonates and infants.
- Magnetic resonance imaging (MRI) is a standard but resource-intensive tool for OSD evaluation.
Purpose of the Study:
- To assess the efficacy of spinal ultrasound in identifying OSD in infants.
- To quantify the concordance between spinal ultrasound and MRI findings for OSD.
Main Methods:
- Retrospective analysis of 85 infants undergoing spinal ultrasound over 31 months.
- Correlation of ultrasound findings with follow-up MRI in 15 selected patients.
- Evaluation of agreement levels: full, partial, and none.
Main Results:
- Overall agreement between ultrasound and MRI was good, with 40% full and 47% partial agreement.
- Ultrasound demonstrated high accuracy for detecting low-lying cords (90%).
- Limitations included visualization failures for certain OSD subtypes like dorsal dermal sinuses and fatty filum terminales.
Conclusions:
- Spinal ultrasound is a valuable first-line screening tool for OSD in infants.
- MRI remains essential for definitive diagnosis when ultrasound is abnormal, equivocal, or technically limited.
- Combining ultrasound screening with MRI as a secondary diagnostic tool optimizes OSD detection and management.
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.
