Cranial Ultrasonography in Pediatrics
Cranial Ultrasonography in Pediatric Diagnostics
Introduction
Cranial ultrasonography represents a vital diagnostic tool in pediatric neuroradiology, offering real-time imaging without ionizing radiation. It's particularly valuable in neonatal and infant assessment through open fontanelles and sutures.
Key Points
- Non-invasive, radiation-free imaging modality
- Real-time visualization of brain structures
- Portable bedside examination capability
- Serial monitoring feasibility
- Cost-effective screening tool
- Limited by closing fontanelles (typically after 12-18 months)
Technical Specifications
Equipment Requirements
- Transducers
- High-frequency (7.5-12 MHz) for superficial structures
- Lower frequency (5-8 MHz) for deeper structures
- Sector, linear, and curved array probes
- Imaging Parameters
- Gray-scale imaging
- Color Doppler capabilities
- Power Doppler assessment
- Spectral Doppler analysis
Scanning Protocol
Standard Views
- Coronal Planes
- C1: Frontal lobes, anterior horns
- C2: Foramen of Monro
- C3: Third ventricle, thalami
- C4: Quadrigeminal cistern
- C5: Cerebellar hemispheres
- Sagittal/Parasagittal Planes
- Midline structures
- Lateral ventricles
- Periventricular white matter
- Additional Views
- Mastoid fontanelle approach
- Posterior fossa views
- Temporal window imaging
Clinical Applications
Primary Indications
- Preterm Infants
- Germinal matrix hemorrhage
- Periventricular leukomalacia
- Post-hemorrhagic hydrocephalus
- Screening protocols
- Term Infants
- Hypoxic-ischemic injury
- Congenital anomalies
- Vascular malformations
- Infections
Pathological Findings
Common Abnormalities
- Hemorrhage
- Germinal matrix hemorrhage (Grade I-IV)
- Subdural hemorrhage
- Cerebellar hemorrhage
- Ischemic Injury
- Periventricular leukomalacia
- Focal infarction
- Watershed injury
- Structural Abnormalities
- Ventriculomegaly
- Cystic malformations
- Midline defects
Advanced Applications
Doppler Assessment
- Resistive Index Measurement
- Normal values by age
- Pathological alterations
- Monitoring applications
- Vessel Identification
- Major arterial vessels
- Venous structures
- Vascular malformations
Limitations and Pitfalls
- Operator dependency
- Limited visualization after fontanelle closure
- Poor visualization of cortical surface
- Restricted posterior fossa assessment
- Limited evaluation of subtle parenchymal abnormalities
Documentation Requirements
- Standard Images
- Complete set of coronal views
- Parasagittal series
- Midline sagittal images
- Doppler measurements when indicated
- Measurements
- Ventricular indices
- Resistive indices
- Lesion dimensions
