Normal Findings

Direct brain imaging in the pediatric age group is possible owing to the presence of large fontanelles, which normally remain open until age 6 to 9 months and thereby provide adequate windows to extensively image the brain. Routine imaging consists of a series of coronal and sagittal images typically obtained through the anterior fontanelle. Additional views can be obtained through other windows as necessary. Details regarding cerebrum and cerebellum are routinely seen and include views of the cerebral hemispheres, the deep ganglionic structures, thalami, ventricles, and posterior fossa.

Carotid imaging is typically performed with either a 5- or 7-MHz linear array transducer maintaining a duplex Doppler angle between 30 and 60 degrees and a sample size of 2 to 4 mm. Transverse and longitudinal images of the cervical carotid artery are routinely obtained that provide anatomical detail regarding the cervical carotid bifurcations. Normal flow velocities in the carotid arteries range between 60 and 100 cm/sec. The cervical vertebral arteries can also be evaluated, but this examination is inherently limited owing to the bony spine. The goal of vertebral artery US is to identify stenotic or occlusive disease or retrograde flow such as seen in subclavian steal syndrome. Representative images can be obtained with Doppler waveforms recording the presence and direction of flow.

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