Multimodal approach of cranial ultrasound in children

The potential uses of cranial ultrasound have been overlooked for years because of the advent of fascinating neuroimaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) study. In this article, the authors introduce the developments and refinement in modern pediatric neurosonology. In the past, only neonates with widely open fontanels seemed to be good candidates for cranial ultrasound study. Actually, any tiny skull defect can be used as an acoustic window. And the thin skulls of children do not hinder the ability of ultrasound to obtain acceptable image transcranially. Today, many CT and MRI studies can be replaced with the advanced cranial ultrasound if clinicians or neurologists recognize the advantages. Cranial ultrasound can provide Doppler hemodynamic studies which CT and MRI can not. Only ultrasound can provide convenient, real-time intraoperative guidance and continuous bedside monitoring in patients who need neurological intensive care. Cranial ultrasound also plays an important role in follow-up studies because it is convenient, economical, and safe, especially in children. To obtain all the benefits from an ultrasound study, one has to realize the "multimodal" applications of it, including the applications of all acoustic windows, multifrequency transducers, and hemodynamic study with the aid of power Doppler and contrast agents. With a multimodal approach, physicians can achieve the utmost from the powerful modern cranial ultrasound in pediatric patients.