Updates on Adult Transcranial Doppler, Gray-Scale, and Contrast-enhanced US Techniques.

Area of Science:

• Neuroimaging
• Vascular Ultrasound
• Neurology

Background:

• Transcranial Doppler (TCD) is established for vasospasm, stroke risk, and brain death assessment.
• Traditional nonimaging TCD (niTCD) relies on flow waveforms and standardized depths.
• TCD imaging (TCDi) integrates B-mode, color Doppler, and spectral Doppler for direct anatomical visualization.

Purpose of the Study:

• To provide a comprehensive update on adult transcranial ultrasound (TCS) techniques.
• To emphasize the clinical value and broader adoption of TCD imaging (TCDi).
• To highlight advancements including contrast-enhanced ultrasound (CEUS).

Main Methods:

• Review of gray-scale imaging, Doppler techniques, and CEUS applications in transcranial ultrasound.
• Focus on evidence-based indications and practical techniques for adult neuroimaging.
• Discussion of TCDi's role in neurointensive care and outpatient settings.

Main Results:

• TCDi improves diagnostic confidence and reproducibility through image guidance.
• Transcranial B-mode sonography (TCS) shows promise in adult neurocritical care and outpatient settings.
• Contrast-enhanced US (CEUS) enhances Doppler signals, expanding applications for cerebral perfusion.

Conclusions:

• Transcranial ultrasound, particularly TCDi, is underrecognized despite its clinical value.
• Broader clinical adoption of advanced TCS techniques is encouraged for adult neuroimaging.
• CEUS expands the utility of transcranial US for vascular and perfusion assessments.