Diagnostic Flowchart and Imaging Features of Common Congenital Anomalies of the Neonatal Spine

Abstract

Paediatric spinal pathologies are commonly encountered in clinical practice. This article summarises the normal appearance of lumbar ultrasonography (LUS) and the imaging techniques used to examine the spine in neonates. The last section of this article is a pictorial illustration of ultrasonography and magnetic resonance imaging (MRI) features of common paediatric spinal pathologies. These include filar cyst, arachnoid cyst, filar fibrolipoma, low-lying cord, syringomyelia, myelomeningocele, Chiari malformations and sacrococcygeal teratoma. Current literature and guidelines on the indications for imaging and available modalities for investigation of occult spinal dysraphism are also reviewed. Isolated simple sacral dimple is no longer an indication for neonatal LUS. Indications for LUS include other cutaneous stigmata, abnormal antenatal ultrasound, and low-risk congenital anomalies. For neonates presenting with neurological deficit, discharging lesion or high-risk congenital anomalies, MRI is indicated. This review also proposes a diagnostic flowchart for better triage of patients to the appropriate modality of imaging in order to achieve satisfactory diagnostic accuracy and enhance cost-effectiveness.

Alternate abstract:

小兒脊柱病變於臨床實踐中經常遇見。本文總結了腰椎超聲檢查（LUS）的正常表現和用於檢查新 生兒脊柱的影像技術。文末章節圖解說明常見小兒脊柱病症的超聲和磁共振成像（MRI）特徵。這 些病症包括：絲狀囊腫、蛛網膜囊腫、絲狀纖維脂瘤、脊髓低位、脊髓空洞症、脊髓脊膜膨出、 Chiari氏畸形及骶尾部畸胎瘤。本文亦對當前隱性椎管閉合不全影像檢查指徵和現有診斷方式指徵的 相關文獻和指南作一回顧。孤立單發的骶骨凹不再是新生兒LUS指徵。LUS指徵包括皮膚紅斑、產 前超聲結果異常和低度危險的先天性畸形。如新生兒出現神經功能缺損、排泄障礙或高度危險的先 天性畸形，便有需要進行MRI。為達至令人滿意的診斷準確率及提高成本效益，本文亦提出了一診 斷流程圖以便能更好地把病人分流出去接受適宜的影像檢查。