Related Experiment Video
Updated: Sep 30, 2026
Assessment of Cerebral Lateralization in Children using Functional Transcranial Doppler Ultrasound (fTCD)
Published on: September 27, 2010
Transcranial Doppler sonography in children: review of a seven-year experience
Wolfgang Hirsch1, Wolfgang Hiebsch, Heike Teichler
1Department of Radiology, Martin-Luther-University Halle-Wittenberg, University Hospital, Halle, Germany. W.Hirsch@t-online.de
Insights
Transcranial Doppler sonography (TCD) is ineffective for diagnosing non-specific pediatric headaches. TCD is more valuable for monitoring known vascular conditions in children, not primary diagnosis.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Vascular Ultrasound
Background:
- Transcranial Doppler (TCD) sonography is a non-invasive neuroimaging technique.
- Its utility in pediatric populations, particularly without an open fontanelle, requires evaluation.
- Assessing TCD's diagnostic yield across different pediatric referrals is crucial.
Purpose of the Study:
- To evaluate the effectiveness of transcranial Doppler (TCD) sonography in children.
- To determine the diagnostic value of TCD for various pediatric neurological indications.
- To assess TCD's utility in children aged 0.5 to 18 years.
Main Methods:
- A 7-year retrospective study involving 858 children (mean age 12.7 years).
- Utilized TCD equipment with a 2 MHz pulse wave transducer.
- Children were categorized into three groups based on referral reasons.
Main Results:
- Low positive pathological findings in children with headache/orthostatic dysregulation (0.4%).
- Higher positive rates observed in acute neurological symptoms (5.4%) and other indications (22.2%).
- Overall low positive predictive value (0.50) for detecting abnormalities.
Conclusions:
- TCD is not effective for primary diagnosis of non-specific pediatric headaches or orthostatic dysregulation.
- TCD may offer limited additional value compared to MRI/MRA in children referred for other indications.
- TCD is best utilized for follow-up of known vascular processes (e.g., stenoses) and chronic conditions (e.g., angiitis, sickle cell disease).
Aim:
We report the use of transcranial Doppler sonography (TCD) examinations in children (mean age 12.7 years; range 0.5-18 years) without an open fontanelle, using TCD equipment with a 2 MHz pulse wave transducer. Our results over a 7-year period are described.
Material And Methods:
A total of 858 children were referred from the paediatric outpatient department. All patients were divided into three groups according to the reason for referral.
Results:
We found positive pathological results in the following: (1) headache and orthostatic dysregulation (0.4%, three out of 728); (2) acute neurological symptoms (5.4%, six out of 112); (3) other indications (22.2%, four out of 18). The positive predictive value of finding an abnormality was very low (0.50).
Conclusion:
TCD examination is ineffective in children with non-specific headache or orthostatic dysregulation due to the specific limitations of this method. We found a higher percentage of abnormal results in children referred for other indications. However, since these children usually undergo MR imaging (and MR angiography, if necessary), in our opinion the TCD examination does not add any additional information. The value of TCD in children is not in the primary diagnosis of disease but in the follow up of known vascular processes (e.g. stenoses) or in chronic diseases including angiitis and sickle cell disease.
