Contrast-Enhanced Ultrasound and Elastography Imaging of the Neonatal Brain: A Review

Neonates presenting with neurologic symptoms require rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging (MRI) is currently the most sensitive and specific imaging modality for evaluation of neurological pathology. This modality does come with several challenges in the neonatal population, namely, the need to transport a possibly critically sick neonate to the MRI suite and the necessity of the neonate to remain still for a significant length of time, occasionally requiring sedation. Cranial ultrasound has provided radiologists and clinicians with an invaluable imaging modality that allows of rapid, bedside point of care evaluation without ionizing radiation. The major drawback of cranial ultrasound is its lower sensitivity and specificity for subtle/early lesions. Contrast-enhanced ultrasound (CEUS) and elastography have the potential to improve sensitivity and specificity for a variety of neuropathology but also expand the indications for cranial ultrasound. Goal of this paper is to present and discuss CEUS and elastography for neonatal brain imaging.