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US of the Spinal Cord in Newborns: Spectrum of Normal Findings, Variants, Congenital Anomalies, and Acquired Diseases¹

¹ From the Departments of Pediatrics (K.M.U., T.G., I.G.) and Radiology (M.C.F.), Leopold-Franzen-University, Anichstrasse 35, A-6020 Innsbruck, Austria. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received May 10, 1999; revision requested June 22 and received July 29; accepted August 11. Address correspondence to K.M.U. (e-mail: karin.unsinn@uibk.ac.at).

View larger version (125K): [in a new window]   Figure 1.   Normal anatomy of the spinal canal and its contents in a 10-day-old newborn. Sagittal US scan of the craniocervical junction shows the spinal cord (arrowheads) and central echo complex (arrows), medulla oblongata (2), pons (3), cerebellar vermis and tonsil (4), subarachnoid space (8), vertebral bodies (12), occipital bone (14), and cisterna magna (15).

View larger version (64K): [in a new window]   Figure 2.   Normal anatomy of the spinal canal and its contents in a 3-day-old newborn. Sagittal US scan shows the spinal cord (arrowheads) and central echo complex (arrows), nerve roots (5), subarachnoid space (8), and vertebral bodies (12).

View larger version (120K): [in a new window]   Figure 3.   Normal anatomy of the thoracic spinal canal and its contents in a 5-day-old newborn. Sagittal US scan of the thoracic spinal canal shows the spinal cord (arrowheads) and central echo complex (arrows), subarachnoid space (8), arachnoid and pia mater (9), dura mater (10), and vertebral bodies (12).

View larger version (122K): [in a new window]   Figure 4.   Normal anatomy of the lumbar spinal canal and its contents in a 5-day-old newborn. Sagittal US scan of the lumbar spinal canal shows the spinal cord (arrowheads) and central echo complex (arrows), nerve roots (5), dura mater (10), and vertebral bodies (12).

View larger version (121K): [in a new window]   Figure 5.   Normal anatomy of the lumbar spinal canal and its contents in a 5-day-old newborn. Axial US scan of the spinal canal at the level of L3 shows the nerve roots (5), filum terminale (7), subarachnoid space (8), vertebral body (12), vertebral arch (13), and muscle (16).

View larger version (138K): [in a new window]   Figure 6.   Normal anatomy of the thoracic spinal canal and its contents in a 5-day-old newborn. Axial US scan of the thoracic spinal canal shows the spinal cord (arrowheads) and central echo complex (arrow), nerve roots (5), subarachnoid space (8), dentate ligament (11), vertebral body (12), vertebral arch (13), and muscle (16).

View larger version (120K): [in a new window]   Figure 7.   Normal anatomy of the thoracic spinal canal and its contents in a 5-day-old newborn. Axial US scan of the spinal canal at the level of T12 shows the spinal cord (arrowheads), nerve roots (5), vertebral body (12), vertebral arch (13), and muscle (16).

View larger version (137K): [in a new window]   Figure 8.   Transient dilatation of the central canal in a healthy 3-day-old newborn. Sagittal US scan shows dilatation of the central canal of the lumbar spinal cord (arrows).

View larger version (142K): [in a new window]   Figure 9.   Ventriculus terminalis in a healthy 7-week-old infant. Sagittal US scan of the lumbar spinal canal shows a ventriculus terminalis (arrowheads). 1 = conus medullaris with central echo complex.

View larger version (129K): [in a new window]   Figure 10.   Thoracolumbar myelomeningocele in an 18-day-old newborn. Sagittal US scan shows a dorsally displaced neural placode (1), dilated subarachnoid space (2), and hypoplastic thoracolumbar spinal cord (arrowheads).

View larger version (163K): [in a new window]   Figure 11.   Chiari II syndrome in a 3-week-old newborn with myelomeningocele. Sagittal US scan of the craniocervical junction shows an abnormal caudally positioned cerebellar vermis (arrowheads). 1 = cerebellar hemisphere, arrows = occipital bone.

View larger version (146K): [in a new window]   Figure 12.   Chiari II syndrome in a 1-month-old infant with myelomeningocele. Sagittal US scan of the craniocervical junction shows kinking (arrowheads) of the cervical spinal cord (1).

View larger version (110K): [in a new window]   Figure 13.   Tethering of the spinal cord in a 2-day-old newborn with lumbosacral myelomeningocele. Sagittal US scan shows a dorsally displaced thoracolumbar spinal cord (arrowheads) due to tethering.

View larger version (124K): [in a new window]   Figure 14.   Hydromyelia in a 1-month-old infant in whom lumbar myelomeningocele and thoracic hydromyelia were noted on the 1st day of life. Sagittal US scan shows a dilated central canal (arrows).

View larger version (140K): [in a new window]   Figure 15.   Arachnoid cyst in a 17-day-old newborn with lumbar meningocele. Sagittal US scan shows the thoracic spinal cord (arrowheads) displaced ventrally and compressed by a cyst (1).

View larger version (152K): [in a new window]   Figure 16.   Tethering of the spinal cord in a 4-month-old infant who underwent surgical correction of a lumbosacral myelomeningocele on the 2nd day of life. Axial US scan shows a deformed and displaced neural placode (1) and nerve roots (2) and a dilated subarachnoid space (3).

View larger version (133K): [in a new window]   Figure 17.   Lumbosacral lipomyelocele with associated cutaneous hemangioma in a 6-week-old infant. Sagittal US scan of the lumbosacral region shows an echogenic lipoma (1) adjacent to the dorsal surface of a deformed lumbar spinal cord (2). The lipoma is contiguous with and more echogenic than the subcutaneous fat (3).

View larger version (154K): [in a new window]   Figure 18.   Dorsal dermal sinus in a 4-day-old newborn. Sagittal US scan of the lumbar spinal canal shows an epithelium-lined tract (arrowheads) from the skin to the spinal cord (1). The tract is detectable as an echogenic band within the anechoic subarachnoid space. In the hypoechoic subcutaneous fat, the tract is hardly visible.

View larger version (151K): [in a new window]   Figure 19.   Tight filum terminale syndrome in a 1-month-old infant. Lumbosacral sagittal US scan shows the tip of the conus medullaris positioned normally between L1 and L2, but the filum terminale is thickened (arrowheads).

View larger version (149K): [in a new window]   Figure 20.   Diastematomyelia in a 2-day-old newborn. Axial US scan of the lumbar spinal canal shows left (1) and right (2) hemicords within a dilated spinal canal (arrows). Each hemicord has an eccentric central canal. The dentate ligament can also be seen (arrowhead).

View larger version (113K): [in a new window]   Figure 21a.   Terminal myelocystocele in a 2-month-old infant. (a) Sagittal US scan obtained with a curved-array transducer shows the whole extent of a terminal myelocystocele, with a deformed and displaced spinal cord (1) surrounded dorsally and ventrally by a dilated subarachnoid space (2). 3 = nerve roots. (b) Oblique US scan obtained more caudally with a linear-array transducer shows the nerve roots (3) leaving the deformed spinal cord (1) ventrally. 2 = subarachnoid space. (c) Axial US scan shows posterior spina bifida (1) and the dilated subarachnoid space (2).

View larger version (108K): [in a new window]   Figure 21b.   Terminal myelocystocele in a 2-month-old infant. (a) Sagittal US scan obtained with a curved-array transducer shows the whole extent of a terminal myelocystocele, with a deformed and displaced spinal cord (1) surrounded dorsally and ventrally by a dilated subarachnoid space (2). 3 = nerve roots. (b) Oblique US scan obtained more caudally with a linear-array transducer shows the nerve roots (3) leaving the deformed spinal cord (1) ventrally. 2 = subarachnoid space. (c) Axial US scan shows posterior spina bifida (1) and the dilated subarachnoid space (2).

View larger version (100K): [in a new window]   Figure 21c.   Terminal myelocystocele in a 2-month-old infant. (a) Sagittal US scan obtained with a curved-array transducer shows the whole extent of a terminal myelocystocele, with a deformed and displaced spinal cord (1) surrounded dorsally and ventrally by a dilated subarachnoid space (2). 3 = nerve roots. (b) Oblique US scan obtained more caudally with a linear-array transducer shows the nerve roots (3) leaving the deformed spinal cord (1) ventrally. 2 = subarachnoid space. (c) Axial US scan shows posterior spina bifida (1) and the dilated subarachnoid space (2).

View larger version (175K): [in a new window]   Figure 22.   Thoracic lateral meningocele in a 1-day-old newborn with severe cerebral malformations and scoliosis. Sagittal US scan shows a cystic dilated subarachnoid space (1) with protrusion of the meninges through the intervertebral foramen. The spinal canal (arrows) is enlarged, and the spinal cord (2) is displaced.

View larger version (65K): [in a new window]   Figure 23a.   Caudal regression syndrome in a 2-month-old infant. (a) Radiograph shows amelia of the right lower extremity. (b) Axial US scan shows the lumbar spinal cord (1) in cross section. The left-sided nerve roots are present (arrows), but the right-sided nerve roots are absent.

View larger version (143K): [in a new window]   Figure 23b.   Caudal regression syndrome in a 2-month-old infant. (a) Radiograph shows amelia of the right lower extremity. (b) Axial US scan shows the lumbar spinal cord (1) in cross section. The left-sided nerve roots are present (arrows), but the right-sided nerve roots are absent.

View larger version (73K): [in a new window]   Figure 24a.   Caudal regression syndrome in a 1-day-old newborn with sirenomelia. (a) Radiograph shows aplasia of the lumbar spine and sacrum. (b) Radiograph shows fusion and severe deformation of the lower extremities. (c) Sagittal US scan of the thoracolumbar region shows a blunt-ending thoracic spinal cord (1) at the level of T11.

View larger version (66K): [in a new window]   Figure 24b.   Caudal regression syndrome in a 1-day-old newborn with sirenomelia. (a) Radiograph shows aplasia of the lumbar spine and sacrum. (b) Radiograph shows fusion and severe deformation of the lower extremities. (c) Sagittal US scan of the thoracolumbar region shows a blunt-ending thoracic spinal cord (1) at the level of T11.

View larger version (143K): [in a new window]   Figure 24c.   Caudal regression syndrome in a 1-day-old newborn with sirenomelia. (a) Radiograph shows aplasia of the lumbar spine and sacrum. (b) Radiograph shows fusion and severe deformation of the lower extremities. (c) Sagittal US scan of the thoracolumbar region shows a blunt-ending thoracic spinal cord (1) at the level of T11.

View larger version (131K): [in a new window]   Figure 25.   Syringomyelia in a 2-day-old newborn. Sagittal US scan of the thoracolumbar spinal canal shows a syrinx (1) at the level of T11-T12 and a dilated central canal (arrowheads).

View larger version (121K): [in a new window]   Figure 26a.   Erb paresis of the left upper extremity and the left hemidiaphragm in a 3-day-old newborn after traumatic birth. (a) Radiograph shows an elevated hemidiaphragm on the left side. (b) Sagittal US scan of the thoracic spinal cord shows ventral displacement of the dura mater (arrowheads) by an epidural fluid collection (blood) (1), which was due to a meningeal tear.

View larger version (139K): [in a new window]   Figure 26b.   Erb paresis of the left upper extremity and the left hemidiaphragm in a 3-day-old newborn after traumatic birth. (a) Radiograph shows an elevated hemidiaphragm on the left side. (b) Sagittal US scan of the thoracic spinal cord shows ventral displacement of the dura mater (arrowheads) by an epidural fluid collection (blood) (1), which was due to a meningeal tear.

View larger version (110K): [in a new window]   Figure 27a.   Spinal cord compression in a 6-day-old newborn with metatropic dysplasia. Sagittal (a) and axial (b) US scans of the craniocervical junction show spinal cord compression due to severe narrowing of the cervical spinal canal (arrows).

View larger version (120K): [in a new window]   Figure 27b.   Spinal cord compression in a 6-day-old newborn with metatropic dysplasia. Sagittal (a) and axial (b) US scans of the craniocervical junction show spinal cord compression due to severe narrowing of the cervical spinal canal (arrows).

View larger version (122K): [in a new window]   Figure 28a.   Cerebrospinal fluid leak in a 5-week-old infant after lumbar puncture. Sagittal (a) and axial (b) US scans of the lumbosacral spinal canal show a circumferential epidural cerebrospinal fluid collection (1), which was due to laceration of the dura mater and leptomeninges. The dura (arrowheads) lies close to the narrowed cauda equina (2).

View larger version (122K): [in a new window]   Figure 28b.   Cerebrospinal fluid leak in a 5-week-old infant after lumbar puncture. Sagittal (a) and axial (b) US scans of the lumbosacral spinal canal show a circumferential epidural cerebrospinal fluid collection (1), which was due to laceration of the dura mater and leptomeninges. The dura (arrowheads) lies close to the narrowed cauda equina (2).