Babcock D S, Han B K, Dine M S
Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
AJR Am J Roentgenol. 1988 Jun;150(6):1359-65. doi: 10.2214/ajr.150.6.1359.
This study compares the sonographic and CT findings in a group of infants with macrocrania and correlates those findings with neurologic outcome to determine the diagnostic accuracy and prognostic value of sonography. Sonographic findings in 255 infants with macrocrania are described. Of the 195 term infants examined, 130 had normal sonograms, 11 (5.6%) had significant abnormalities, and 54 had increased intra- and/or extraaxial fluid spaces. Of the 60 former preterm infants, 33 had normal sonograms, four (6.7%) had significant abnormalities, and 23 had increased fluid spaces or small resolving germinal matrix hemorrhages. The patients with significant abnormalities usually had head circumferences greater than the 95th percentile and had neurologic abnormalities. There was good correlation between sonography and CT in 30 of the 36 patients evaluated by both. In six there was mild discrepancy in the volume of the extraaxial fluid. No significant abnormality was missed by sonography. CT did not contribute any additional information. Neurologic follow-up was available for 202 patients. Nineteen percent of the term infants and 24% of the former preterm infants were abnormal on neurologic follow-up. Most patients with normal sonograms were normal on follow-up. Twelve of the term and four of the preterm infants with normal sonograms were developmentally delayed on follow-up. Increased CSF in the ventricles and/or extraaxial spaces was a common abnormality, but it usually is associated with a normal neurologic outcome and represents "benign macrocrania." We conclude that an infant with an enlarged or enlarging head should have a neurologic examination and head circumference measurement. If the patient has a head circumference greater than the 95th percentile, particularly if there are abnormal neurologic findings, further evaluation is indicated. Sonography is the initial procedure recommended since it accurately evaluates ventricular size, extraaxial fluid, and congenital malformations. If sonography is normal or shows mildly increased fluid spaces, then follow-up head circumference measurement and clinical evaluation will probably suffice. CT is indicated if there is a significant abnormality on sonography that requires further clarification.
本研究比较了一组巨头症婴儿的超声和CT检查结果，并将这些结果与神经学预后相关联，以确定超声检查的诊断准确性和预后价值。描述了255例巨头症婴儿的超声检查结果。在接受检查的195例足月儿中，130例超声检查正常，11例（5.6%）有明显异常，54例有脑室内和/或脑外间隙增宽。在60例 former preterm 婴儿中，33例超声检查正常，4例（6.7%）有明显异常，23例有间隙增宽或正在吸收的小生发基质出血。有明显异常的患者头围通常大于第95百分位且有神经学异常。在接受两种检查的36例患者中，30例超声与CT检查结果相关性良好。6例患者脑外间隙的体积有轻度差异。超声检查未遗漏任何明显异常。CT检查未提供任何额外信息。202例患者有神经学随访资料。19%的足月儿和24%的 former preterm 婴儿神经学随访结果异常。大多数超声检查正常的患者随访结果也正常。12例超声检查正常的足月儿和4例超声检查正常的 former preterm 婴儿随访时有发育迟缓。脑室内和/或脑外间隙脑脊液增多是常见异常，但通常与正常神经学预后相关，代表“良性巨头症”。我们得出结论，头部增大或正在增大的婴儿应进行神经学检查和头围测量。如果患者头围大于第95百分位，特别是如果有异常神经学表现，则需进一步评估。超声检查是推荐的初始检查方法，因为它能准确评估脑室大小、脑外间隙液体及先天性畸形。如果超声检查正常或显示间隙轻度增宽，那么随访头围测量和临床评估可能就足够了。如果超声检查有明显异常需要进一步明确，则需进行CT检查。
