State of the Art Cranial Ultrasound Imaging in Neonates

Abstract

Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed. Video LinkThe video component of this article can be found at

State-of-the-art neonatal cerebral ultrasound: technique and reporting

“…In stable preterm infants born after 28 weeks of gestation, the frequency of serial CUS can be limited to days 1, 3, 7, 14, 28, at 6 weeks, and at termequivalent age. 25 Additional scans outside suggested schedules should be performed whenever clinically indicated. The first CUS after admission serves to rule out antenatal brain injury and congenital malformation.…”

“…The first CUS after admission serves to rule out antenatal brain injury and congenital malformation. 25 The scans during the first week of life aim to detect germinal matrix-IVH, periventricular hemorrhagic infarction, and cerebellar hemorrhage. [26][27][28][29][30] In at least 50% of the affected infants, the onset of germinal matrix-IVH is on the first day of life, and by 72 h approximately 90% of the lesions are identified.…”

“…Although neonatal CUS settings can be pre-programmed (which is recommended as starting point), settings will have to be optimized individually to prevent overlooking important features. 25 Different pathologies often require specific settings. Knowledge of several aspects regarding hardware and software is essential for optimal use of the technique.…”

Identifying infant hydrocephalus in the emergency department with transfontanellar POCUS

“…The ventricular system of the infant brain can be visualized with transducer frequencies ranging between 5 MHz to 10 MHz. This frequency range is achievable with the phased-array, endocavitary, neonatal curvilinear, and even linear transducer [6][7][8]. In order to insonate the brain and visualize the ventricles, the footprint of the transducer is placed directly onto the middle of the open anterior fontanelle.…”

Transtemporal Ultrasound (US) Assessment of Third Ventricle Diameter (TVD): Comparison of US and MRI TVD in Pediatric Patients

“…In small children with patent anterior fontanelle, ventricular visualization is usually achieved using transfontanelle ultrasound (US). 3,4 In older children, regular evaluation of the ventricular width is, so far, performed using magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain with known side effects as radiation exposure, compliance problems with MRI in small children requiring sedation or general anesthesia, higher costs, and longer duration of the examination.…”