Pediatric Radiology

, Volume 35, Issue 1, pp 54–65 | Cite as

Transcranial Doppler imaging in children: sickle cell screening and beyond

  • Lisa H. LoweEmail author
  • Dorothy I. Bulas


Transcranial Doppler (TCD) is widely accepted as the modality of choice for screening intracranial vessels in children with sickle cell disease. Its advantages are that it is noninvasive (no need for sedation, contrast material, or radiation), portable, easily repeated, and it provides information about the intracranial vessels that is otherwise unavailable. These positive attributes explain why in recent years the applications for TCD have grown beyond sickle cell screening to almost any disease process that involves the major intracranial vessels. The objective of this manuscript is to discuss key points on how to perform and interpret TCD, and discuss imaging features of various pathological processes such as sickle cell, asphyxia, brain trauma, brain death, hydrocephalus, enlarged subarachnoid spaces, vasospasm, vasculitis, venous sinus thrombosis, and vein of Galen malformation.


Transcranial Doppler Ultrasound Sickle cell disease Sonography Children 


  1. 1.
    Aaslid R, Markwalder TM, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774PubMedGoogle Scholar
  2. 2.
    Jones AM, Seibert JJ, Nichols FT, et al (2001) Comparison of transcranial color Doppler imaging (TCDI) and transcranial Doppler (TCD) in children with sickle-cell anemia. Pediatr Radiol 31:461–469CrossRefPubMedGoogle Scholar
  3. 3.
    Bulas DI, Jones A, Seibert JJ, et al (2000) Transcranial Doppler (TCD) screening for stroke prevention in sickle cell anemia: pitfalls in technique variation. Pediatr Radiol 30:733–738CrossRefPubMedGoogle Scholar
  4. 4.
    Bulas DI (1999) Transcranial Doppler: applications in pediatrics. Appl Radiol 28:7–15CrossRefGoogle Scholar
  5. 5.
    Seibert JJ, Glasier CM, Kirby RS, et al (1998) Transcranial Doppler, MRA, and MRI as a screening examination for cerebrovascular disease in patients with sickle cell anemia: an 8-year study. Pediatr Radiol 28:138–142CrossRefPubMedGoogle Scholar
  6. 6.
    Adams R, McKie V, Hsu L, et al (1998) Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on TCD. N Eng J Med 339:5–11CrossRefGoogle Scholar
  7. 7.
    Pegelow CH, Adams RJ, McKie V, et al (1995) Risk of recurrent stroke in patients with sickle cell disease treated with erythrocyte transfusions. J Pediatr 126:896–899PubMedGoogle Scholar
  8. 8.
    Adams RJ (2000) Lessons from the stroke prevention trial in sickle cell anemia (STOP) study. J Child Neurol 15:344–349PubMedGoogle Scholar
  9. 9.
    Chadduck WM, Seibert JJ (1989) Intracranial duplex Doppler: practical uses in pediatric neurology and neurosurgery. J Child Neurol 4[Suppl]:S77–S86PubMedGoogle Scholar
  10. 10.
    Seibert JJ, McCowan TC, Chadduck WM, et al (1989) Duplex pulsed Doppler US versus intracranial pressure in the neonate: clinical and experimental studies. Radiology 171:155–159PubMedGoogle Scholar
  11. 11.
    Archer LN, Levene MI, Evans DH (1986) Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. Lancet 2:1116–1118CrossRefPubMedGoogle Scholar
  12. 12.
    Stark JE, Seibert JJ (1994) Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. J Ultrasound Med 13:595–600PubMedGoogle Scholar
  13. 13.
    Bada HS, Hajjar W, Chua C, et al (1979) Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound. J Pediatr 95:775–779PubMedGoogle Scholar
  14. 14.
    Saliba EM, Laugier J (1992) Doppler assessment of the cerebral circulation in pediatric intensive care. Crit Care Clin 8:79–92PubMedGoogle Scholar
  15. 15.
    Blankenberg FG, Loh NN, Norbash AM, et al (1997) Impaired cerebrovascular autoregulation after hypoxic-ischemic injury in extremely low-birth-weight neonates: detection with power and pulsed wave Doppler US. Radiology 205:563–568PubMedGoogle Scholar
  16. 16.
    Steiger H, Aeslid R, Stooss R, et al (1994) Transcranial Doppler monitoring in head injury: relations between type of injury, flow velocities, vasoreactivity and outcome. Neurosurgery 34:79–86PubMedGoogle Scholar
  17. 17.
    Ducrocq X, Braun M, Debouverie M, et al (1998) Brain death and transcranial Doppler: experience in 130 cases of brain dead patients. J Neurol Sci 160:41–46CrossRefPubMedGoogle Scholar
  18. 18.
    Ducrocq X, Hassler W, Moritake K, et al (1998) Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: task force group on cerebral death of the neurosonology research group of the world federation of neurology. J Neurol Sci 159:145–150CrossRefPubMedGoogle Scholar
  19. 19.
    Glasier CM, Seibert JJ, Chadduck WM, et al (1989) Brain death in infants: evaluation with Doppler US. Radiology 172:377–380PubMedGoogle Scholar
  20. 20.
    Powers AD, Graeber MC, Smith RR (1989) Transcranial Doppler ultrasonography in the determination of brain death. Neurosurgery 24:884–889PubMedGoogle Scholar
  21. 21.
    Kirkham FJ, Levin SD, Padayachee TS, et al (1987) Transcranial pulsed Doppler ultrasound findings in brain stem death. J Neurol Neurosurg Psychiatry 50:1504–1513PubMedGoogle Scholar
  22. 22.
    Chiu NC, Shen EY, Lee BS (1994) Reversal of diastolic cerebral blood flow in infants without brain death. Pediatr Neurol 11:337–340CrossRefPubMedGoogle Scholar
  23. 23.
    Goh D, Minns RA (1995) Intracranial pressure and cerebral arterial flow velocity indices in childhood hydrocephalus: current review. Childs Nerv Syst 11:392–396PubMedGoogle Scholar
  24. 24.
    DeWitt LD, Wechsler LR (1988) Transcranial Doppler. Stroke 19:915–921PubMedGoogle Scholar
  25. 25.
    Taylor GA, Madsen JR (1996) Neonatal hydrocephalus: hemodynamic response to fontanelle compression-correlation with intracranial pressure and need for shunt placement. Radiology 201:685–689PubMedGoogle Scholar
  26. 26.
    Taylor GA (2001) Sonographic assessment of posthemorrhagic ventricular dilatation. Radiol Clin North Am 39:541–551PubMedGoogle Scholar
  27. 27.
    Taylor GA, Phillips MD, Ichord RN, et al (1994) Intracranial compliance in infants: evaluation with Doppler US. Radiology 191:787–791PubMedGoogle Scholar
  28. 28.
    Hurst RW, Schnee C, Raps EC, et al (1993) Role of transcranial Doppler in neuroradiological treatment of intracranial vasospasm. Stroke 24:299–303PubMedGoogle Scholar
  29. 29.
    Grosset DG, Straiton J, du Trevou M, et al (1992) Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. Stroke 23:674–679PubMedGoogle Scholar
  30. 30.
    Morello FP (2002) Vasculitis in children and adolescents. Sem Interv Radiol 19:89–97CrossRefGoogle Scholar
  31. 31.
    Hoffmann M, Corr P, Robbs J (2000) Cerebrovascular findings in Takayasu disease. J Neuroimaging 10:84–90PubMedGoogle Scholar
  32. 32.
    Morgenlander JC, McCallum RM, Devlin T, et al (1996) Transcranial doppler sonography to monitor cerebral vasculitis. J Rheumatol 23:561–563PubMedGoogle Scholar
  33. 33.
    Razumovsky AY, Wityk RJ, Geocadin RG, et al (2001) Cerebral vasculitis: diagnosis and follow-up with transcranial Doppler ultrasonography. J Neuroimaging 11:333–335PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of Pediatric RadiologyChildren’s Mercy Hospital and The University of Missouri-Kansas CityKansas CityUSA
  2. 2.Department of Pediatric RadiologyChildren’s National Medical Center and George Washington UniversityWashingtonUSA

Personalised recommendations