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Pediatric Cranial Ultrasound: Techniques, Variants and Pitfalls

Recent advances in sonographic technology have made ultrasound an increasingly accurate and adequate means to detect cranial morphology and intracranial pathology in infants. When modern equipment is combined with thorough imaging technique, ultrasound delivers similar results to MRI in terms of sensitivity and ability to direct initial management (Daneman et. al, 2006; Epelman et. al., 2010). Furthermore, ultrasound offers certain advantages over other imaging modalities such as MRI and CT. Cranial sonography is less expensive, spares the patient from radiation, does not require sedation, and its portability allows for bedside evaluation in gravely ill infants who cannot be transported to radiology for imaging. The goal of this chapter is to provide an updated approach to modern cranial ultrasound in order to improve diagnostic accuracy and increase recognition of normal anatomical structures, anatomical variants, pathologic processes, and imaging pitfalls that may simulate disease. The discussion will begin with an overview of the approach and interpretation of gray-scale imaging. The chapter will continue with a review of Doppler imaging, the use of additional fontanels, and linear imaging. The chapter will conclude by reviewing pitfalls and normal variants which may simulate pathology.