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Approach to neuroimaging in children

Jill V Hunter, MD
Section Editors
Douglas R Nordli, Jr, MD
Eric D Schwartz, MD
Deputy Editor
John F Dashe, MD, PhD


Imaging modalities can be classified as structural or functional [1-3]. Structural imaging modalities provide spatial resolution based primarily upon anatomic or morphologic data. Functional imaging modalities provide spatial resolution based upon physiologic or metabolic data. Some techniques provide both structural and functional information.

The major imaging modalities for structural and functional evaluation of the developing central nervous system (CNS) are ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques [2,3]. Ultrasonography and CT provide rapid screening for gross macrostructural abnormalities. Nuclear medicine techniques may offer additional functional data. MRI in current clinical use and advanced MR techniques often provide the most definitive macrostructural, microstructural, and functional imaging information.


The resolving power of ultrasonography (US) is based upon variations in acoustic reflectance of tissues. This technique has many advantages. It is readily accessible, portable, and fast; images are viewed in real time and are multiplanar [1,4]. It is less expensive than other cross sectional modalities and is considered relatively noninvasive because it does not involve ionizing radiation. Furthermore, US requires no contrast agent, and patient sedation rarely is needed.

However, US also has certain limitations. The diagnostic effectiveness of US depends primarily upon the skill and experience of the operator and interpreter. In addition, US requires a window or path for cranial and spinal imaging that is unimpeded by bone or air. Thus, US can be used for neuroimaging in the fetus during a prenatal examination and in the infant who has an open fontanelle and sutures. US also can be used to examine the immature or dysplastic cranium or spine (eg, dysraphism), the orbit, and the neck [1,4,5].

Safety issues — Medical US is generally considered safe. However, concerns have been raised regarding the use of ultrasonography for nonmedical imaging of the fetus [6,7]. These concerns include the deposition of radio-frequency from the current generation of machines with 3D and 4D capabilities. As with radiation, the principle of "as low as reasonably achievable" (ALARA) should be followed during ultrasonography to maintain the lowest possible exposure to mechanical and thermal indices.

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Literature review current through: Nov 2017. | This topic last updated: Mar 16, 2016.
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