新生児から乳児期早期における脊髄超音波検査の有用性

DOI
  • 前島 基志
    独立行政法人国立成育医療研究センター臨床検査部(現・独立行政法人国立国際医療研究センター病院中央検査部)
  • 東澤 恭介
    独立行政法人国立成育医療研究センター臨床検査部
  • 安井 一浩
    独立行政法人国立成育医療研究センター臨床検査部
  • 宮坂 実木子
    独立行政法人国立成育医療研究センター放射線診療部
  • 堤 義之
    独立行政法人国立成育医療研究センター放射線診療部
  • 野坂 俊介
    独立行政法人国立成育医療研究センター放射線診療部
  • 長田 裕次
    国立療養所栗生楽泉園研究検査科
  • 松林 守
    独立行政法人国立成育医療研究センター臨床検査部
  • 宮崎 澄夫
    独立行政法人国立国際医療研究センター病院中央検査部
  • 奥山 虎之
    独立行政法人国立成育医療研究センター臨床検査部

書誌事項

タイトル別名
  • Usefulness of Spinal Ultrasonography in the Neonate and Early Infants

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Introduction: While magnetic resonance imaging (MRI) is useful for evaluating the spinal cord, it can be difficult to perform on pediatric patients who may require sedation. Ultrasonography (US) can however be performed to evaluate the spinal cords of neonatal and infant patients with incomplete ossification. This technique has the advantage of being performed noninvasively without sedation. This study evaluated spinal ultrasonography findings from neonates and infants and compared them with cases that underwent MRI.<br>Subjects and Methods: The subjects comprised 128 (61 males and 67 females) patients <7 months of age (mean age, 1 month) who underwent spinal US from April 2010 to March 2011. US involved placing the patients in the prone position and using a linear probe to identify the lumbosacral vertebral level and rendering the spinal cord. Thereafter, the lower edge of the conus medullaris was identified, and the motion of the filum terminale and cauda equina was observed. The US findings included identifying the lower edge of the conus medullaris, spinal cord and spinal cord area findings, and movement of the cauda equina nerve. US diagnostic ability for a low-lying conus medullaris was evaluated by comparing the results with 38 cases that underwent MRI at a later date. The US equipment used was an AplioXG instrument (Toshiba, Tokyo, Japan) with PLT-805AT and PLT-1204BT probes or an ACUSON S2000 instrument (Siemens AG, Erlangen, Germany) with an 18L6 probe.<br>Results and Discussion: All the cases were evaluated from the area between the vertebral arches to the spinal cord/conus medullaris or filum terminale. US findings from the lower edge of the conus medullaris revealed 32 cases of a low-lying conus medullaris and two cases of a difficult to identify low-lying conus medullaris. US spinal cord and spinal cord area findings revealed 15 cases of filar cysts, 12 cases of spinal lipomas, one case of lumbar syringomyelia, and one case of sacral cystic lesion. The cauda equina nerve movement findings indicated four cases with impaired mobility. The diagnostic ability for a low-lying conus medullaris in the 38 cases whose US findings could be compared with those of MRI revealed a true positive result in 15 cases, a true negative result for 12 cases, a false positive result in 11 cases, and a false negative result in 0 cases. Thus, sensitivity was 100%, specificity was 52%, and accuracy was 71%. The following could have been the possible reasons for US false positive results: changes in the height of the lower edge of the conus medullaris over time from the neonate period through infancy; the limited number of testing positions; artifacts caused by patient movement or vertebral arch ossification; and the presence of normal variations or malformations in the number of ribs and vertebrae.<br>Conclusions: The results revealed that spinal US is a noninvasive and simple method for performing a real-time dynamic assessment of neonate and early infants and suggests that US might be useful as a screening examination for spinal lesions in this cohort.

収録刊行物

  • 超音波検査技術

    超音波検査技術 39 (1), 11-21, 2014

    一般社団法人 日本超音波検査学会

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