State of the art cranial ultrasound imaging in neonates.
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.
Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital.
Ginette M
GM
Ecury-Goossen
Department of Radiology, Erasmus MC-Sophia Children's Hospital.
Fleur A
FA
Camfferman
Department of Pediatrics, Division of Neonatology, UZ Brussel; Department of Pediatrics, Division of Neonatology, Leiden University Medical Center.
Lara M
LM
Leijser
Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Pediatrics, Division of Neonatology, Isala Hospital.
Paul
P
Govaert
Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Radiology, Erasmus MC-Sophia Children's Hospital; j.dudink@erasmusmc.nl.
Jeroen
J
Dudink
D001921:Brain / Q000033:anatomy & histology* / Q000098:blood supply; D001927:Brain Diseases / Q000000981:diagnostic imaging; D004453:Echoencephalography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation / Q000379:methods