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Updated: Aug 10, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Cerebral High-Frame-Rate Ultrasound Imaging and Its Possibilities in the Neonatal Intensive Care Unit
Anna J Kortenbout1, Fleur A Camfferman2, Wieke Kagenaar3
1Department of Cardiology, Thorax Biomedical Engineering, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Objective:
Impaired cerebral blood flow in preterm neonates is a risk factor for developing brain injury. High-frame-rate (HFR) ultrasound (US) imaging using plane-wave transmissions enables spectral Doppler-based flow analysis in all imaging pixels with high spatiotemporal resolution and sensitivity, potentially providing a better indicator of neonatal cerebral blood flow. The aim was to investigate the feasibility of HFR US in measuring cerebral blood flow velocities in the periventricular zone of newborn infants. Secondary aims: (i) differentiate between venous and arterial flow, (ii) investigate the impact of unilateral brain injury on blood flow and (iii) examine the influence of patient variables on HFR results.
Methods:
In a prospective cohort study, 2-D HFR US imaging data in (pre)term infants were recorded with a custom HFR mode on a Zonare ZS3 system with a high-frequency linear probe (L20-5). Data were analyzed offline to calculate peak systolic velocity (PSV), end diastolic velocity, resistivity index and the new flow index (FI), defined as the average PSV across all blood flow pixels within a region of interest.
Results:
HFR US was performed in 81 patients (118 HFR recordings) of which 72 recordings were excluded due to technical limitations or insufficient image quality. In the remaining 46 recordings, arterial and venous flow could be reliably distinguished. In neonates with unilateral intracranial pathology (n = 12), the median FI was higher on the affected side (1.62, IQR 1.48-1.79) compared to the contralateral side (1.41, IQR 1.33-1.50; p = 0.002). Across all recordings, FI showed no significant correlation with birth weight (ρ = 0.11, p = 0.42), post-menstrual age (ρ = 0.07, p = 0.56), z-scores or mean airway pressure in ventilated infants.
Conclusion:
Obtaining qualitative and quantitative flow indices with HFR US imaging is feasible in a population of neonates. HFR-derived perfusion indices may play an important role in understanding and preventing neonatal brain injury.
