Tips And Tricks Of Neonatal Transcranial Ultrasound

Document Type : Original Article


Division of Pediatric Radiology, Department of Radiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands


Transcranial ultrasound is an ideal imaging modality of the brain in (premature) neonates. Ultrasound is a non-ionizing technique, offers the important benefit of being a fast and bedside examination, does not require sedation, and is relative inexpensive. The diagnostic accuracy of cranial ultrasound is, for specific indications, comparable with magnetic resonance imaging (MRI). In most cases, however,MRI provides more detailed and specific information. Transcranial ultrasound is very helpful in determining initial clinical management, especially in critically ill (premature) neonates who are at risk for intracranial problems.
Thorough knowledge of the ultrasound appearance of the normal intracranial anatomy is crucial for adequate interpretation of imaging findings. Improvements in sonographic equipment lead to more frequent visualization of a variety of anatomic variants. Awareness of these variations is important to avoid pitfalls that may mimic pathologic abnormalities. Furthermore, familiarity with the main indications for transcranial ultrasound of the neonatal brain plays a key role in recognizing the different pathologies. Intracranial hemorrhage, hydrocephalus, periventricular leukomalacia and hypoxic- ischemic encephalopathy are amongst the major intracranial pathologies in critically ill (premature) neonates.
The objective is to discuss an approach for transcranial ultrasound, including a brief review of the intracranial anatomy and anatomic variants, the use of multiple fontanels, the value of linear imaging and screening Doppler techniques, and their importance in recognizing different critical conditions in the (premature) neonate.