- Ultrasound spinal canal first 3–4 months: Ultrasound can be used in the early neonatal and infant period for the evaluation of suspected spinal dysraphism. It can only be used prior to ossification of the posterior elements, which prevents the transmission of ultrasound waves. From a practical point of view, this means that use of ultrasound is limited to the first three or four months of life.
Subcutaneous lipoma, lateral view in an infant with a lipomyelomeningocele: Lipomyelomeningocele is typically sited at the lumbosacral junction. The lipoma has a smooth contour.
Subcutaneous lipoma, posterior view, in an infant with a lipomyelomeningocele: Although the lipoma may be asymmetric it will at least in part overlie the midline. Superficial hemangiomas commonly present in the overlying skin.
Sagittal ultrasound image of lipomyelomeningocele in an infant: The spinal cord is low lying in the sacral spinal canal. The spinal cord terminates in the subcutaneous fat.
Sagittal MRI scan of lipomyelomeningocele in an infant: The anatomical detail is improved relative to ultrasound. The attachment of the spinal cord placode to the subcutaneous lipoma and its relationship to the cerebrospinal fluid spaces is clearly shown (blue arrow).
- Confirmatory MRI: If there is a high index of suspicion of spinal pathology, even a normal ultrasound should be followed by MRI, since pathology can be missed on ultrasound (3).
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