HUS Cranial Ultrasound: From Technical Innovations to Clinical Applications

Abstract Conventional adult transcranial ultrasound allows bedside acquisition of cerebral structural and hemodynamic data, featuring repeatable radiation-free scanning tailored to clinical monitoring demands. Nevertheless, its clinical application is substantially limited by the adult temporal bone, which induces ultrasonic signal attenuation, wavefront distortion and reverberation artifacts. High-penetration ultrafast cranial ultrasound (HUS) effectively overcomes these skull-derived imaging limitations through synergistic integration of low-frequency single-crystal phased array detection, ultrafast plane-wave imaging, spatiotemporal clutter suppression, and high-resolution transcalvarial reconstruction. This innovative platform achieves contrast-free two-dimensional transtemporal imaging with a structural resolution of 1-2 mm, enabling clear visualization of basal anatomical landmarks, the Circle of Willis, proximal intracranial arteries, and major intracranial venous structures. This review summarizes the technical innovations of HUS and its progress in applications including the diagnosis of neurodegenerative diseases such as Parkinson’s disease, noninvasive monitoring of intracranial hemorrhage and intracranial pressure in neurocritical care, integrated cervico-cerebrovascular evaluation, and psychiatric disorders. The clinical utility of HUS for refined bedside management of intracranial pathologies is discussed.