State of the Art Cranial Ultrasound Imaging in Neonates
February 2nd, 2015
Cranial ultrasound (CUS) is a valuable tool for brain imaging in critically ill neonates. This video shows a comprehensive approach for neonatal (Doppler) CUS for both clinical and research purposes, including a bedside demonstration of the technique.
The overall goal of this procedure is to demonstrate a state-of-the-art neonatal cranial ultrasound technique. We will focus on the use of different transducers, multiple acoustic windows and doppler techniques After calibration of the imager, a series of at least five coronal and sagittal plane images are acquired through the anterior fontanel.Color. Doppler is used to visualize intracranial vessels and use of supplemental acoustic windows improves detection of brain injury.
The main advantages of this technique over other neuroimaging techniques, such as magnetic resonance imaging are its relatively low cost. The fact that it can be performed at bedside, that it is radiation free and allows for serial imaging Before beginning the procedure, install the ultrasound machine along the incubator and then apply transducer gel to the probe to ensure good contact between the probe and the skin. When the instrument is ready, place a probe in B mode in the middle of the anterior fontanel with the marker on the probe turned to the right side of the neonate to start the imaging through the anterior fontanel.
The left side of the brain will be displayed on the right side of the monitor. Begin recording. Use the first image to adjust the depth gain and time.
Gain compensation settings to produce an image filling the sector and containing the cranial contours. Avoid too bright or too dark images, and aim for an equilibrium between the reflections from the nearby and deeper structures. For the coronal prefrontal image angle, the probe forward to visualize the frontal lobes anterior to the frontal horns of the lateral ventricles at the level of the olfactory sulci.
For the coronal image at the level of Monroe angle the probe to visualize the coronal section anterior to the teal caria to depict the frontal horns of the lateral ventricles. The kam septi pellucid eye, the corpus cossum, and the sulcus ingul eye, noting the echogenicity of the parts of the basal ganglia. For the coronal image at the level of the thalamus angle, the probe backwards to identify the lateral fissures, the teia in the roof of the third ventricle and the temporal lobes.
Note the echogenicity of the thalamus, especially the ventral lateral nuclei in relation to the basal ganglia.Network. Injury in the pul may also be visualized in an extra coronal section just in front of the atria for the coronal image at the level of the atria. Visualize the lateral ventricles at the level of the choroid plexus and identify the temporal lobes and cerebellar hemispheres.
Note the echogenicity of the paraventricular white matter compared to the choroid plexus, and compare the optic radiation with the normal hypoechoic areas above and lateral to the atria. In preterm neonates for the coronal parietal occipital image angle the probe backwards to the level of the parietal occipital sulcus. To identify the parietal and occipital lobes.
Now rotate the probe 90 degrees so that the marker on the probe faces toward the neonates face. The anterior part of the brain will be displayed on the left side of the monitor. For the mid sagittal image, visualize the corpus cossum, the cave's septi lucid eye, the third and fourth ventricles, the verus cisterna, magna the pons and the mesencephalon, noting the presence of the ka virgi and the kava vili interi.
For the para sagittal image through the right ganglio thalamic ovoid angle the probe sideways for a para sagittal view through the lateral ventricle, and identify the choroid plexus, noting the echogenicity of the thalamus and the basal ganglia. For the para sagittal insular image, angle the probe further lateral through the insula and identify the lateral fissure and the frontal temporal parietal and occipital lobes. Then repeat the para sagittal images for the contralateral side.
Use color doppler in a coronal plane through the anterior fontanel to visualize the transverse sinuses at the level of the cerebellum. If only one or none of the transverse sinuses is visualized, try lowering the pulse repetition frequency. If only one or none of the transverse sinuses still can't be identified through the anterior fontanel, use a high frequency linear probe for visualization through the mastoid fontanel.
Visualize the circle of Willis with the internal carotid arteries, the middle cerebral arteries, and the anterior cerebral arteries. At the level of the frontal horns of the lateral ventricles. Identify the stri aal candelabra of arteries, and then angle the probe backwards to visualize the basilar artery with the adjacent jugular veins.
Angle the probe further backwards to visualize the internal cerebral and thalamus strate veins, and then using a high frequency linear probe in a coronal plane. In the anterior fontanel, identify the superior sagittal sinus. If it is necessary to obtain images through the lateral window.
Place the probe horizontally above and slightly in front of the ear and move the probe until the cerebral peduncles are visualized. Other structures that can be identified are the third ventricle, aqueduct, and temporal lobes. Using color doppler, the circle of Willis can be visualized to obtain a coronal view through the mastoid fontanel.
Place the convex probe parallel to the ear. Start recording images sweeping the probe back and forth to identify the cerebellar hemispheres, the verus the third and fourth ventricles, the pons and the cisterna magna. In small preterms.
The contralateral cerebellar hemisphere may be well depicted. Use a linear probe to image through the mastoid fontanel. If one of the transverse sinuses cannot be identified through the anterior fontanel, use a high frequency linear probe placing the instrument parallel to the ear lobe to obtain a coronal view.
Finally, identify the cerebellar hemisphere and the fourth ventricle, and then use color doppler to identify the transverse sigmoid and tentorial sinuses and the emissary veins. Symmetrical imaging is necessary for adequate interpretation of coronal images made through the anterior fonte. Any suspected lesion should be visualized in both a coronal and a sagittal plane or by visualization through an acoustic window.
Other than the anterior fontanel color, Doppler should be used for visualization of the intra cerebral vessels. In this image, a right posterior cerebral artery stroke can be observed, and in this image through the posterior fontanel acoustic window, a clot in the lateral ventricle can be seen. In this image, the lateral fontanel was used as an acoustic window and a sal venous infarction can be observed.
Reliable measurement using ellipsoid and free tracing tools is part of routine imaging. For example, ventricular measurements such as the ventricular index, the anterior horn width, and the Alamo occipital distance are used in clinical practice. To monitor ventricular size In experienced hands, doppler cranial ultrasound is an excellent tool for safe serial bedside neonatal brain imaging.
Optimal use of currently available equipment and techniques provides even better imaging quality and improves diagnostic value of cranial ultrasound.
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Overview
This video demonstrates a state-of-the-art neonatal cranial ultrasound (CUS) technique for brain imaging in critically ill neonates. It highlights the use of various transducers and Doppler techniques, showcasing a bedside demonstration of the imaging process.
Key Study Components
Area of Science
- Neonatal brain imaging
- Cranial ultrasound techniques
- Doppler imaging
Background
- Cranial ultrasound is a valuable tool for assessing brain conditions in neonates.
- It is cost-effective and can be performed at the bedside.
- The technique is radiation-free and allows for serial imaging.
- Color Doppler enhances visualization of intracranial vessels.
Purpose of Study
- To demonstrate a comprehensive approach to neonatal cranial ultrasound.
- To illustrate the use of different acoustic windows for improved detection of brain injury.
- To provide a practical guide for clinicians and researchers.
Methods Used
- Calibration of the ultrasound imager.
- Acquisition of coronal and sagittal plane images through the anterior fontanel.
- Application of transducer gel for optimal contact.
- Use of B mode imaging to start the procedure.
Main Results
- Successful visualization of intracranial vessels using Doppler techniques.
- Improved detection of brain injuries through supplemental acoustic windows.
- Demonstration of the technique's advantages over MRI.
- Effective bedside implementation of cranial ultrasound.
Conclusions
- Cranial ultrasound is a practical and effective tool for neonatal brain imaging.
- The technique offers significant advantages in critical care settings.
- Further research can enhance its application in clinical practice.
Frequently Asked Questions
Executive Industry Relevance
State-of-the-art cranial ultrasound imaging in neonates provides a non-invasive, radiation-free modality for high-frequency, serial brain monitoring in vulnerable populations. Its bedside applicability and advanced Doppler capabilities enable rapid, quantitative assessment of cerebral structures and vascular patency, supporting translational research and early biomarker discovery. This imaging platform enhances predictive confidence and de-risks early-stage neurodevelopmental studies in biopharma R&D pipelines.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables real-time visualization of neonatal brain structures for hypothesis-driven studies.
- Supports functional assessment of cerebral vasculature using Doppler indices.
- Facilitates detection of early brain injury, informing target validation in neurodevelopmental research.
- Improves mechanistic de-risking by allowing serial, quantitative imaging in preclinical models.
Screening & Assay Development
- Provides standardized imaging protocols for reproducible assessment across studies.
- Delivers quantitative measurements such as ventricular indices and flow velocities for assay development.
- Enables scalable, bedside imaging workflows suitable for high-throughput screening in neonatal models.
- Supports reliable evaluation of candidate interventions on brain structure and perfusion.
Translational & Preclinical Research
- Aligns with disease-relevant endpoints by detecting cerebral injury and vascular events in neonates.
- Ensures continuity from discovery to preclinical validation through serial, non-invasive imaging.
- Enables early detection of cerebral sinovenous thrombosis, supporting translational biomarker strategies.
- Reduces biological risk by providing actionable imaging data for risk-adjusted advancement decisions.
Pipeline & Workflow Integration
Cranial ultrasound imaging integrates into the discovery-to-preclinical continuum by enabling hypothesis testing, quantitative readouts, and translational alignment in neonatal brain research.
- Discovery Biology: Supports pathway clarification and biological de-risking via real-time brain imaging.
- Screening: Standardizes quantitative outputs such as ventricular size and flow indices for cross-study comparability.
- Analytics: Provides reproducible measurements and Doppler-derived indices for robust statistical analysis.
- Translational Research: Bridges early discovery with preclinical endpoints relevant to neonatal brain injury and vascular pathology.
- Enterprise Reuse: Offers a reusable imaging platform adaptable across neonatal and pediatric research models.
Operational & Enterprise Impact
- Scientific Value: Enhances predictive confidence and target validation in neurodevelopmental pipelines.
- Operational Value: Delivers standardized, scalable, and reproducible imaging workflows for serial studies.
- Strategic Value: Improves go/no-go decision-making and reduces late-stage biological risk in neonatal programs.
- Portfolio Impact: Enables risk-adjusted prioritization and advancement of neurodevelopmental assets.
Implementation Considerations
- Requires expertise in neonatal cranial ultrasound technique and Doppler interpretation.
- Needs access to high-quality ultrasound equipment with multiple probes and Doppler capabilities.
- Demands standardized imaging protocols and data storage infrastructure for reproducibility.
- Must adapt imaging parameters for different neonatal and preterm populations.
- Dependent on operator skill for optimal image acquisition and interpretation.
