Figure 9.

Measuring VI (A–C) and AHW (D–F) with obscured ventricular borders. Coronal ultrasound scans in 3 different preterm infants at the level of the frontal horns of the lateral ventricles. (A–C) VI measurements (solid line) and reference aid (dotted line). (D–F) Anterior horn width measurement (solid line) and reference aid (dotted line). It can occasionally be challenging to measure ventricular size when the ependymal margin of the ventricle is either obscured by echogenic clot (B,E) or interrupted by porencephalic cyst (C,F). (A,D) Grade I GMH-IVH. Small clot at the caudothalamic notch causes local extrinsic mass effect, “pushes” into, and partially effaces the frontal horn of the lateral ventricle. In cases like this, the AHW measurement should extend partially across the germinal matrix clot to reach the imaginary continuation of the lower ventricular wall as its reference point. (B,E) Grade III GMH-IVH with frontal PVHI. In this example, the correctly measured AHW will extend partially across the echogenic clot, but not include the portion that is believed intraparenchymal in location. (C,F) Porencephalic cyst. A ghost outline of the ventricle can occasionally still be seen (arrowheads) and aids definition of ventricular size. In this example, the correctly positioned reference aid across the long axis of the ventricle will assist measurement of the AHW (placed perpendicular to the reference aid).