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O'Brien NF, Reuter-Rice K, Wainwright MS, Kaplan SL, Appavu B, Erklauer JC, Ghosh S, Kirschen M, Kozak B, Lidsky K, Lovett ME, Mehollin-Ray AR, Miles DK, Press CA, Simon DW, Tasker RC, LaRovere KL. Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement. J Pediatr Intensive Care 2021; 10:133-142. [PMID: 33884214 PMCID: PMC8052112 DOI: 10.1055/s-0040-1715128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Transcranial Doppler ultrasonography (TCD) is being used in many pediatric intensive care units (PICUs) to aid in the diagnosis and monitoring of children with known or suspected pathophysiological changes to cerebral hemodynamics. Standardized approaches to scanning protocols, interpretation, and documentation of TCD examinations in this setting are lacking. A panel of multidisciplinary clinicians with expertise in the use of TCD in the PICU undertook a three-round modified Delphi process to reach unanimous agreement on 34 statements and then create practice recommendations for TCD use in the PICU. Use of these recommendations will help to ensure that high quality TCD images are captured, interpreted, and reported using standard nomenclature. Furthermore, use will aid in ensuring reproducible and meaningful study results between TCD practitioners and across PICUs.
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Affiliation(s)
- Nicole Fortier O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Karin Reuter-Rice
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, School of Nursing, Duke University, Duke Institute for Brain Sciences, North Carolina, United States
| | - Mark S. Wainwright
- Department of Neurology, University of Washington, Seattle Children's Hospital, Washington, United States
| | - Summer L. Kaplan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brian Appavu
- Department of Pediatrics, Division of Critical Care Medicine, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine—Phoenix, Arizona, United States
| | - Jennifer C. Erklauer
- Department of Pediatrics, Division of Critical Care Medicine and Neurology, Baylor College of Medicine, Texas Children's Hospital, Texas, United States
| | - Suman Ghosh
- Department of Pediatrics, Division of Pediatric Neurology, University of Florida, College of Medicine, Florida, United States
| | - Matthew Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brandi Kozak
- Department of Radiology, Ultrasound Division, Center for Pediatric Contrast Ultrasound, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Karen Lidsky
- Department of Pediatrics, Division of Pediatric Critical Care, Wolfson Children's Hospital, University of Florida, Florida, United States
| | - Marlina Elizabeth Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Amy R. Mehollin-Ray
- Department of Radiology, Baylor College of Medicine, E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Texas, United States
| | - Darryl K. Miles
- Department of Pediatrics/Division of Critical Care, UT Southwestern Medical Center, Texas, United States
| | - Craig A. Press
- Department of Pediatrics, Section of Child Neurology, University of Colorado, Children's Hospital Colorado, Colorado, United States
| | - Dennis W. Simon
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania, United States
| | - Robert C. Tasker
- Departments of Neurology & Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
| | - Kerri Lynn LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
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2
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Yoshizuka T, Kinoshita M, Iwata S, Tsuda K, Kato T, Saikusa M, Shindou R, Hara N, Harada E, Takashima S, Takeshige N, Saitoh S, Yamashita Y, Iwata O. Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry with fontanel compression. Sci Rep 2018; 8:11824. [PMID: 30087390 PMCID: PMC6081432 DOI: 10.1038/s41598-018-30274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/24/2018] [Indexed: 11/09/2022] Open
Abstract
For infants with acute progressive hydrocephalus, invasive drainage of cerebrospinal fluid (CSF) is performed until a ventriculo-peritoneal shunt can be inserted. Surrogate markers of intracranial pressure (ICP) may help optimise the timing of invasive procedures. To assess whether RI with/without fontanel compression helps distinguish between infants with normal (<5 cmH2O), mild (5-11 cmH2O), and moderate (>11 cmH2O) ICP elevation, 74 ICP measures before/after CSF removal and 148 related Doppler measures of the middle cerebral artery were assessed. Higher RI was associated with fontanel compression, elevated ICP, and their interaction (all p < 0.001). Without compression, differences in RI were observed between normal and moderate (p < 0.001) and between mild and moderate ICP elevation (p = 0.033). With compression, differences in RI were observed for all pairwise comparisons among normal, mild, and moderate ICP elevation (all p < 0.001). Without compression, areas under the receiver-operating characteristic curve for prediction of mild and moderate ICP elevation were 0.664 (95% confidence interval (CI), 0.538-0.791; p = 0.020) and 0.727 (95% CI, 0.582-0.872; p = 0.004), respectively, which improved to 0.806 (95% CI, 0.703-0.910; p < 0.001) and 0.814 (95% CI, 0.707-0.921; p < 0.001), respectively, with compression. RI with fontanel compression provides improved discrimination of infants with absent, mild, and moderate ICP elevation.
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Affiliation(s)
- Teiko Yoshizuka
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Masahiro Kinoshita
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takenori Kato
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mamoru Saikusa
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryota Shindou
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Naoko Hara
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Eimei Harada
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sachio Takashima
- Yanagawa Institute for Developmental Disabilities, International University of Health and Welfare, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yushiro Yamashita
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
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3
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Diwakar RK, Khurana O. Cranial Sonography in Preterm Infants with Short Review of Literature. J Pediatr Neurosci 2018; 13:141-149. [PMID: 30090126 PMCID: PMC6057202 DOI: 10.4103/jpn.jpn_60_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Premature newborn infants are exposed to a wide spectrum of brain lesions which are clinically silent supporting a possible role of cerebral ultrasound screening. Aim of the study is to describe the pattern of cranial ultrasound abnormalities in preterm infants defining the short term and long term neurologic outcomes. Material and Methods: A hospital-based bedside cranial ultrasound was carried out at day 1, 3, 7 and follow-up scan at 3-6 months in the Department of Radio-diagnosis. Results: One hundred infants were included. The different abnormalities detected in cranial ultrasound of premature newborn infants include hydrocephalus in 12%, intracranial hemorrhage in 6%, brain edema in 6%, periventricular leukomalacia in 2%, choroid plexus cyst in 1%, intraventricular septa in 1% and colocephaly in 1%. Conclusion: Gestational age, newborn birth weight and neurologic symptoms were the most important risk factors for detecting brain lesions. The main purpose of cranial ultrasound was the demonstration or exclusion of an intracranial hemorrhage in a preterm neonate.
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Affiliation(s)
- Rajendra K Diwakar
- Department of Radio Diagnosis, CCM Medical College and Hospital, Kurud Road, Kachandur, Durg, Chhattisgarh, India
| | - Omesh Khurana
- Department of Paediatrics, CCM Medical College and Hospital, Kurud Road, Kachandur, Durg, Chhattisgarh, India
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Kanavaki A, Spengos K, Moraki M, Delaporta P, Kariyannis C, Papassotiriou I, Kattamis A. Serum Levels of S100b and NSE Proteins in Patients with Non-Transfusion-Dependent Thalassemia as Biomarkers of Brain Ischemia and Cerebral Vasculopathy. Int J Mol Sci 2017; 18:ijms18122724. [PMID: 29244749 PMCID: PMC5751325 DOI: 10.3390/ijms18122724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022] Open
Abstract
Patients with non-transfusion-dependent thalassemia (NTDT) are at risk of developing brain ischemia. Transcranial Doppler (TCD) has been established as a useful screening tool of cerebrovascular disease in patients with sickle cell disease. Proteins neuron specific enolase (NSE) and S100B are biomarkers that reflect CNS injury. The purpose of this study is to evaluate cerebral vessel vasculopathy and brain damage in NTDT patients using non-invasive methods as TCD and measurement serum levels of NSE and S100B. We included in our study 30 patients with NTDT, aged between 8 and 62 years old (mean: 29.4, median: 32) who presented in our Unit for regular follow-up. We performed in all patients a non-imaging TCD examination and have measured serum S100, NSE and lactate dehydrogenase (LDH) levels. We investigated the possible correlation between TCD results and S100B, NSE and LDH levels as well as between NSE-LDH and S100B-LDH levels by regression analysis. We found a statistically significant relationship for both NSE, S100B with LDH. We also found a statistically significant relationship for S100B and time-averaged mean velocity (TAMV)/peak velocity of left middle cerebral artery (MCA), NSE and pulsatility index (PI)/resistive index (RI) of the left posterior cerebral artery (PCA). TCD results correlated with biomarkers for brain ischemia. This finding enhances the role of TCD as a screening tool for brain ischemia in patients with NTDT.
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Affiliation(s)
- Aikaterini Kanavaki
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (P.D.); (A.K.)
- Correspondence: ; Tel.: +30-21-0618-4000
| | - Konstantinos Spengos
- First Department of Neurology, “Eginition” Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Maria Moraki
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (P.D.); (A.K.)
| | - Polyxeni Delaporta
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (P.D.); (A.K.)
| | - Catherine Kariyannis
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Goudi, 11527 Athens, Greece; (C.K.); (I.P.)
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Goudi, 11527 Athens, Greece; (C.K.); (I.P.)
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (P.D.); (A.K.)
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Urban A, Golgher L, Brunner C, Gdalyahu A, Har-Gil H, Kain D, Montaldo G, Sironi L, Blinder P. Understanding the neurovascular unit at multiple scales: Advantages and limitations of multi-photon and functional ultrasound imaging. Adv Drug Deliv Rev 2017; 119:73-100. [PMID: 28778714 DOI: 10.1016/j.addr.2017.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 02/07/2023]
Abstract
Developing efficient brain imaging technologies by combining a high spatiotemporal resolution and a large penetration depth is a key step for better understanding the neurovascular interface that emerges as a main pathway to neurodegeneration in many pathologies such as dementia. This review focuses on the advances in two complementary techniques: multi-photon laser scanning microscopy (MPLSM) and functional ultrasound imaging (fUSi). MPLSM has become the gold standard for in vivo imaging of cellular dynamics and morphology, together with cerebral blood flow. fUSi is an innovative imaging modality based on Doppler ultrasound, capable of recording vascular brain activity over large scales (i.e., tens of cubic millimeters) at unprecedented spatial and temporal resolution for such volumes (up to 10μm pixel size at 10kHz). By merging these two technologies, researchers may have access to a more detailed view of the various processes taking place at the neurovascular interface. MPLSM and fUSi are also good candidates for addressing the major challenge of real-time delivery, monitoring, and in vivo evaluation of drugs in neuronal tissue.
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Affiliation(s)
- Alan Urban
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium; Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Golgher
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Clément Brunner
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium
| | - Amos Gdalyahu
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagai Har-Gil
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - David Kain
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Montaldo
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium
| | - Laura Sironi
- Physics Dept., Universita degli Studi di Milano Bicocca, Italy
| | - Pablo Blinder
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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6
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Greenwood S, Deane C, Rees OL, Freedman B, Kumar S, Ben Ramadan N, Wilkinson S, Marais G, Lord J, Chakravorty S, Height SE, Gardner K, Rees DC. The significance of inadequate transcranial Doppler studies in children with sickle cell disease. PLoS One 2017; 12:e0181681. [PMID: 28742875 PMCID: PMC5526506 DOI: 10.1371/journal.pone.0181681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
Sickle cell disease (SCD) is a common cause of cerebrovascular disease in childhood. Primary stroke prevention is effective using transcranial Doppler (TCD) scans to measure intracranial blood velocities, and regular blood transfusions or hydroxycarbamide when these are abnormal. Inadequate TCD scans occur when it is not possible to measure velocities in all the main arteries. We have investigated the prevalence and significance of this in a retrospective audit of 3915 TCD scans in 1191 children, performed between 2008 and 2015. 79% scans were normal, 6.4% conditional, 2.8% abnormal and 12% inadequate. 21.6% of 1191 patients had an inadequate scan at least once. The median age of first inadequate scan was 3.3 years (0.7-19.4), with a U-shaped frequency distribution with age: 28% aged 2-3 years, 3.5% age 10 years, 25% age 16 years. In young children reduced compliance was the main reason for inadequate TCDs, whereas in older children it was due to a poor temporal ultrasound window. The prevalence of inadequate TCD was 8% in the main Vascular Laboratory at King's College Hospital and significantly higher at 16% in the outreach clinics (P<0.0001), probably due to the use of a portable ultrasound machine. Inadequate TCD scans were not associated with underlying cerebrovascular disease.
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Affiliation(s)
- Simon Greenwood
- Vascular Laboratory, King’s College Hospital, London, United Kingdom
| | - Colin Deane
- Vascular Laboratory, King’s College Hospital, London, United Kingdom
| | | | - Ben Freedman
- Vascular Laboratory, King’s College Hospital, London, United Kingdom
| | - Suresh Kumar
- Department of Paediatrics, Darent Valley Hospital, Dartford, Kent, United Kingdom
| | - Naser Ben Ramadan
- Department of Paediatrics, Medway Maritime Hospital, Gillingham, Kent, United Kingdom
| | - Sarah Wilkinson
- Department of Paediatrics, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Grant Marais
- Department of Paediatrics, Croydon University Hospital, London, United Kingdom
| | - Julie Lord
- Department of Paediatrics, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King’s College Hospital, London, United Kingdom
| | - Susan E. Height
- Department of Paediatric Haematology, King’s College Hospital, London, United Kingdom
| | - Kate Gardner
- Department of Paediatric Haematology, King’s College Hospital, London, United Kingdom
| | - David C. Rees
- Department of Paediatric Haematology, King’s College Hospital, London, United Kingdom
- * E-mail:
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7
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LaRovere KL, O'Brien NF. Transcranial Doppler Sonography in Pediatric Neurocritical Care: A Review of Clinical Applications and Case Illustrations in the Pediatric Intensive Care Unit. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2121-32. [PMID: 26573100 DOI: 10.7863/ultra.15.02016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/31/2015] [Indexed: 05/25/2023]
Abstract
Transcranial Doppler sonography is a noninvasive, real-time physiologic monitor that can detect altered cerebral hemodynamics during catastrophic brain injury. Recent data suggest that transcranial Doppler sonography may provide important information about cerebrovascular hemodynamics in children with traumatic brain injury, intracranial hypertension, vasospasm, stroke, cerebrovascular disorders, central nervous system infections, and brain death. Information derived from transcranial Doppler sonography in these disorders may elucidate underlying pathophysiologic characteristics, predict outcomes, monitor responses to treatment, and prompt a change in management. We review emerging applications for transcranial Doppler sonography in the pediatric intensive care unit with case illustrations from our own experience.
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Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts USA (K.L.L.); and Department of Pediatrics, Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital and Ohio State University, Columbus, Ohio USA (N.F.O.).
| | - Nicole F O'Brien
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts USA (K.L.L.); and Department of Pediatrics, Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital and Ohio State University, Columbus, Ohio USA (N.F.O.)
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8
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Korraa AA, El Nagger AAI, Mohamed RAES, Helmy NM. Impact of kangaroo mother care on cerebral blood flow of preterm infants. Ital J Pediatr 2014; 40:83. [PMID: 25391600 PMCID: PMC4234866 DOI: 10.1186/s13052-014-0083-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 10/12/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) has been widely used to improve the care of preterms and low birth weight infants. However, very little is known about cerebral hemodynamics responses in preterm infants during KMC intervention. The aim of this study is to evaluate the changes of cerebral blood flow (CBF) in middle cerebral artery, before and after a 30 minute application of KMC in stable preterm infants. METHODS It is a prospective, pre-post test without a control group study. CBF flow paremeters were measured with Doppler ultrasonography in one middle cerebral artery. Sixty preterm stable infants were assessed before and after 30 min KMC. CBF indices were assessed in different positions before KMC, forty neonates in supine position and 20 in vertical suspension (baby is held vertically away from the skin of his mother). Other dependent variables heart rate and mean arterial blood pressure and Spo2 were also studied before and after KMC. RESULTS The mean gestational age of the infants was (32 ± 2 weeks), and mean birth weight was (2080 ± 270 gm). Comparing CBF indices (Pulsatility index and Resistive index) before and after KMC has shown a significant decrease in both Pulsatility index (PI) and Resistive index (RI) after 30 min. KMC, the mean values were (2.0 ± 0.43 vs 1.68 ± 0.33 & 0.81 ± 0.05 vs 0.76 ± 0.06 respectively P < 0.05*) with mean difference (0.32 & 95% CI 0.042-0.41 & 0.05 & 95% CI 0.04 to 0.06 respectively P < 0.05*) and increase in end diastolic velocity & mean velocity 30 min of KMC (10.97 ± 4.63 vs. 15.39 ± 5.66 P < 0.05*& 25.66 ± 10.74 vs. 32.86 ± 11.47 P < 0.05* ) with mean difference (- 4.42 & 95% CI -5.67 to -3.18 and -7.21 & 95% CI - 9.41 to 5.00 respectively). These changes indicate improvement in CBF. No correlation has been found between CBF parameters and studied vital signs or SpO2. CONCLUSION Kangaroo mother care improves cerebral blood flow, thus it might influence the structure and promote development of the premature infant's brain.
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Affiliation(s)
- Afaf A Korraa
- Pediatrics department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
| | - Alyaa A I El Nagger
- Radiology department, faculty of medicine, Al-Azhar University, Cairo, Egypt.
| | | | - Noha M Helmy
- Pediatrics department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
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9
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Dinan D, Epelman M, Guimaraes CV, Donnelly LF, Nagasubramanian R, Chauvin NA. The current state of imaging pediatric hemoglobinopathies. Semin Ultrasound CT MR 2014; 34:493-515. [PMID: 24332202 DOI: 10.1053/j.sult.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The hemoglobinopathies are a group of genetic disorders with a broad spectrum of clinical manifestations and radiologic findings. The imaging of pediatric hemoglobinopathies, which is influenced by concomitant hemosiderosis and the sequela of chelation therapy, has evolved over the years along with ever-improving technology. This article reviews and illustrates the most common radiographic and cross-sectional imaging findings of the 2 best known and clinically relevant hemoglobinopathies in pediatric patients, sickle cell disease and β-thalassemia.
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Affiliation(s)
- David Dinan
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL.
| | | | | | | | - Nancy A Chauvin
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
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10
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Urban A, Mace E, Brunner C, Heidmann M, Rossier J, Montaldo G. Chronic assessment of cerebral hemodynamics during rat forepaw electrical stimulation using functional ultrasound imaging. Neuroimage 2014; 101:138-49. [PMID: 25008960 DOI: 10.1016/j.neuroimage.2014.06.063] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/10/2014] [Accepted: 06/27/2014] [Indexed: 01/29/2023] Open
Abstract
Functional ultrasound imaging is a method recently developed to assess brain activity via hemodynamics in rodents. Doppler ultrasound signals allow the measurement of cerebral blood volume (CBV) and red blood cells' (RBCs') velocity in small vessels. However, this technique originally requires performing a large craniotomy that limits its use to acute experiments only. Moreover, a detailed description of the hemodynamic changes that underlie functional ultrasound imaging has not been described but is essential for a better interpretation of neuroimaging data. To overcome the limitation of the craniotomy, we developed a dedicated thinned skull surgery for chronic imaging. This procedure did not induce brain inflammation nor neuronal death as confirmed by immunostaining. We successfully acquired both high-resolution images of the microvasculature and functional movies of the brain hemodynamics on the same animal at 0, 2, and 7 days without loss of quality. Then, we investigated the spatiotemporal evolution of the CBV hemodynamic response function (HRF) in response to sensory-evoked electrical stimulus (1 mA) ranging from 1 (200 μs) to 25 pulses (5s). Our results indicate that CBV HRF parameters such as the peak amplitude, the time to peak, the full width at half-maximum and the spatial extent of the activated area increase with stimulus duration. Functional ultrasound imaging was sensitive enough to detect hemodynamic responses evoked by only a single pulse stimulus. We also observed that the RBC velocity during activation could be separated in two distinct speed ranges with the fastest velocities located in the upper part of the cortex and slower velocities in deeper layers. For the first time, functional ultrasound imaging demonstrates its potential to image brain activity chronically in small animals and offers new insights into the spatiotemporal evolution of cerebral hemodynamics.
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Affiliation(s)
- Alan Urban
- Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France.
| | - Emilie Mace
- 1A Allée des bois de Gagny, 93340 Le Raincy, France
| | - Clément Brunner
- Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Marc Heidmann
- Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean Rossier
- Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - Gabriel Montaldo
- Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Paris, France
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11
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Winchell AM, Taylor BA, Song R, Loeffler RB, Grundlehner P, Hankins JS, Wang WC, Ogg RJ, Hillenbrand CM, Helton KJ. Evaluation of SWI in children with sickle cell disease. AJNR Am J Neuroradiol 2014; 35:1016-21. [PMID: 24263696 DOI: 10.3174/ajnr.a3794] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE SWI is a powerful tool for imaging of the cerebral venous system. The SWI venous contrast is affected by blood flow, which may be altered in sickle cell disease. In this study, we characterized SWI venous contrast in patients with sickle cell disease and healthy control participants and examined the relationships among SWI venous contrast, and hematologic variables in the group with sickle cell disease. MATERIALS AND METHODS A retrospective review of MR imaging and hematologic variables from 21 patients with sickle cell disease and age- and sex-matched healthy control participants was performed. A Frangi vesselness filter was used to quantify the attenuation of visible veins from the SWI. The normalized visible venous volume was calculated for quantitative analysis of venous vessel conspicuity. RESULTS The normalized visible venous volume was significantly lower in the group with sickle cell disease vs the control group (P < .001). Normalized visible venous volume was not associated with hemoglobin, percent hemoglobin F, percent hemoglobin S, absolute reticulocyte count, or white blood cell count. A hypointense arterial signal on SWI was observed in 18 of the 21 patients with sickle cell disease and none of the 21 healthy control participants. CONCLUSIONS This study demonstrates the variable and significantly lower normalized visible venous volume in patients with sickle cell disease compared with healthy control participants. Decreased venous contrast in sickle cell disease may reflect abnormal cerebral blood flow, volume, velocity, or oxygenation. Quantitative analysis of SWI contrast may be useful for investigation of cerebrovascular pathology in patients with sickle cell disease, and as a tool to monitor therapies. However, future studies are needed to elucidate physiologic mechanisms of decreased venous conspicuity in sickle cell disease.
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Affiliation(s)
- A M Winchell
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - B A Taylor
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - R Song
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - R B Loeffler
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - P Grundlehner
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - J S Hankins
- Hematology (J.S.H., W.C.W.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - W C Wang
- Hematology (J.S.H., W.C.W.), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - R J Ogg
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - C M Hillenbrand
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
| | - K J Helton
- From the Departments of Radiological Sciences (A.M.W., B.A.T., R.S., R.B.L., P.G., R.J.O., C.M.H., K.J.H.)
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12
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Verlhac S, Balandra S, Cussenot I, Kasbi F, Vasile M, Kheniche A, Elmaleh-Bergès M, Ithier G, Benkerrou M, Bernaudin F, Sebag G. Extracranial carotid arteriopathy in stroke-free children with sickle cell anemia: detection by submandibular Doppler sonography. Pediatr Radiol 2014; 44:587-96. [PMID: 24595876 DOI: 10.1007/s00247-014-2880-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/18/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral vasculopathy is a serious complication of sickle cell anemia. Overt strokes are largely due to intracranial arteriopathy, detected by routine transcranial Doppler and largely prevented through chronic transfusions. As extracranial internal carotid artery arteriopathy was considered rare, it has not been routinely assessed in sickle cell anemia. Recent cases of overt strokes associated with stenosis/occlusion of the extracranial portion of the internal carotid artery prompted us to include extracranial internal carotid artery assessment to our transcranial Doppler sonography protocol. OBJECTIVE The aim of the study was to perform a cross-sectional study in children with sickle cell anemia to evaluate Doppler flow patterns of the extracranial internal carotid arteries and to assess potential associated factors. MATERIALS AND METHODS Between June 2011 and April 2012, 435 consecutive stroke-free children with sickle cell anemia (200/235 M/F, median age: 7.9 years) were assessed for extracranial internal carotid artery using a 2-MHz transcranial Doppler sonography probe via a submandibular window during routine transcranial Doppler sonography visits. The course of both extracranial internal carotid artery was assessed by color Doppler mapping, and the highest flow velocity was recorded after insonation of the entire length of the artery and analyzed. Intra- and extracranial MR angiographies were available in 104/435 subjects for comparison. RESULTS Mean (SD) extracranial internal carotid artery time-averaged mean of maximum velocity was 96 (40) cm/s. Extracranial internal carotid artery tortuosities were echo-detected in 25% cases and were more frequent in boys (33% vs.18%; P < 0.001). Velocity ≥160 cm/s in at least one extracranial internal carotid artery was found in 45 out of 435 patients with sickle cell anemia (10.3%) and was highly predictive of MR angiography stenosis. Simultaneous abnormal intracranial velocity (≥200 cm/s) was recorded in 5/45 patients, while 40 patients had isolated extracranial internal carotid artery velocity ≥160 cm/s. Low hemoglobin (odds ratio: 1.9/g/dL, 95% confidence interval (CI): 1.3-2.9; P = 0.001) and tortuosities (odds ratio: 19.2, 95% CI: 7.1-52.6; P < 0.001) were significant and independent associated factors for isolated extracranial internal carotid artery velocities ≥160 cm/s. CONCLUSION Adding extracranial internal carotid artery evaluation via the submandibular window to transcranial Doppler sonograpy allowed us to detect 10.3% patients at risk for extracranial internal carotid arteriopathy. Further studies are needed to evaluate the prognosis of these anomalies.
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Affiliation(s)
- Suzanne Verlhac
- Department of Pediatric Imaging, University Paris VII, Assistance-Publique-Hôpitaux de Paris, Hospital Robert Debré, Paris, France,
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13
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Rao VK, Haridas A, Nguyen TT, Lulla R, Wainwright MS, Goldstein JL. Symptomatic cerebral vasospasm following resection of a medulloblastoma in a child. Neurocrit Care 2013; 18:84-8. [PMID: 22911499 DOI: 10.1007/s12028-012-9769-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vasospasm may occur following intracranial tumor resection but is uncommon following resection of tumors in the posterior fossa. METHODS Case report. RESULTS Here, we report an unusual pediatric case of symptomatic cerebral vasospasm following resection of a posterior fossa medulloblastoma in a 10-year-old child. CT angiogram and serial Transcranial Doppler (TCD) studies confirmed the presence of vasospasm and response to hemodynamic augmentation therapy, resulting in favorable outcome. CONCLUSION This case illustrates an unusual complication of posterior fossa tumor resection, and the potential utility of TCD studies in the detection and management of vasospasm in pediatric neurocritical care.
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Affiliation(s)
- Vamshi K Rao
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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14
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Shariat A, Nazeri M, Abolhasani Foroughi A, Karimi M. Transcranial Doppler Ultrasonography in Beta-thalassemia Major Patients Without and With Thrombocytosis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:234-8. [PMID: 23984004 PMCID: PMC3745753 DOI: 10.5812/ircmj.4606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 06/15/2012] [Accepted: 01/23/2013] [Indexed: 12/03/2022]
Abstract
Background Beta-thalassemia is a type of anemia in which the patients may require splenectomy and this can lead to thrombocytosis with increased risk of stroke. Transcranial Doppler ultrasound is a method for determining cerebral vessel stenosis. Objectives The aim of this study was to investigate whether the risk of a future stroke secondary to cerebral artery stenosis can be predicted with the use of transcranial Doppler ultrasound in beta-thalassemia major patients. Patients and Methods This study included 54 beta-thalassemia major patients divided into 2 groups; group A consisted of 28 patients who have thrombocytosis secondary to a previous splenectomy and group B comprised of 26 patients who did not have a splenectomy with normal platelet count, as well as a control group of 30 healthy individuals. Results Transcranial Doppler ultrasound of the cerebral vessels were performed in all participants, and the results for each group were compared with the controls. In addition, patients were evaluated for evidence of high flow velocity in the cerebral vessels that met the clinically significant criteria of ≥ 50% stenosis. Transcranial Doppler ultrasound velocity criteria for > 50% stenosis, indicating a risk of stroke, were not documented in any patients but increase in cerebral blood velocities in many arteries in group A and in some arteries in group B were revealed. Conclusion Following splenectomy, thrombocytosis can predispose the patients to an increase in cerebral blood velocities more than respected with anemia. But by transcranial doppler ultrasonography no evidence of significant stenosis were found in intracerebral arteries to conclude that the beta-thalassemia major patients were more prone to the development of stroke secondary to this abnormality.
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Affiliation(s)
- Abdolhamid Shariat
- Department of Neurology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Masoume Nazeri
- Department of Neurology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amin Abolhasani Foroughi
- Medical Imaging Research Center, Department of Radiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mehran Karimi, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7116473239, E-mail:
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Aleem I, Chau T. Towards a hemodynamic BCI using transcranial Doppler without user-specific training data. J Neural Eng 2012; 10:016005. [PMID: 23234760 DOI: 10.1088/1741-2560/10/1/016005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Transcranial Doppler (TCD) was recently introduced as a new brain-computer interface (BCI) modality for detecting task-induced hemispheric lateralization. To date, single-trial discrimination between a lateralized mental activity and a rest state has been demonstrated with long (45 s) activation time periods. However, the possibility of detecting successive activations in a user-independent framework (i.e. without training data from the user) remains an open question. OBJECTIVE The objective of this research was to assess TCD-based detection of lateralized mental activity with a user-independent classifier. In so doing, we also investigated the accuracy of detecting successive lateralizations. Approach. TCD data from 18 participants were collected during verbal fluency, mental rotation tasks and baseline counting tasks. Linear discriminant analysis and a set of four time-domain features were used to classify successive left and right brain activations. MAIN RESULTS In a user-independent framework, accuracies up to 74.6 ± 12.6% were achieved using training data from a single participant, and lateralization task durations of 18 s. SIGNIFICANCE Subject-independent, algorithmic classification of TCD signals corresponding to successive brain lateralization may be a feasible paradigm for TCD-BCI design.
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Affiliation(s)
- Idris Aleem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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16
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AIUM practice guideline for the performance of a transcranial Doppler ultrasound examination for adults and children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1489-1500. [PMID: 22922633 DOI: 10.7863/jum.2012.31.9.1489] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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17
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Myrden AJB, Kushki A, Sejdić E, Guerguerian AM, Chau T. A brain-computer interface based on bilateral transcranial Doppler ultrasound. PLoS One 2011; 6:e24170. [PMID: 21915292 PMCID: PMC3168473 DOI: 10.1371/journal.pone.0024170] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 08/01/2011] [Indexed: 11/19/2022] Open
Abstract
In this study, we investigate the feasibility of a BCI based on transcranial Doppler ultrasound (TCD), a medical imaging technique used to monitor cerebral blood flow velocity. We classified the cerebral blood flow velocity changes associated with two mental tasks - a word generation task, and a mental rotation task. Cerebral blood flow velocity was measured simultaneously within the left and right middle cerebral arteries while nine able-bodied adults alternated between mental activity (i.e. word generation or mental rotation) and relaxation. Using linear discriminant analysis and a set of time-domain features, word generation and mental rotation were classified with respective average accuracies of 82.9%10.5 and 85.7%10.0 across all participants. Accuracies for all participants significantly exceeded chance. These results indicate that TCD is a promising measurement modality for BCI research.
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Affiliation(s)
- Andrew J B Myrden
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
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State-of-the-art cranial sonography: Part 1, modern techniques and image interpretation. AJR Am J Roentgenol 2011; 196:1028-33. [PMID: 21512067 DOI: 10.2214/ajr.10.6160] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In this era of radiation awareness, high-quality ultrasound is more important than ever. Although cranial sonography equipment has advanced greatly, application of modern techniques has not been utilized in a fashion commensurate to other cross-sectional modalities. This article will describe modern cranial sonography techniques, including the utility of linear imaging, use of additional fontanels, and screening Doppler imaging. CONCLUSION When modern protocols are used, cranial sonography is highly accurate for the detection of cranial abnormalities.
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Verlhac S. Transcranial Doppler in children. Pediatr Radiol 2011; 41 Suppl 1:S153-65. [PMID: 21523592 DOI: 10.1007/s00247-011-2038-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 12/31/2010] [Accepted: 01/13/2011] [Indexed: 11/28/2022]
Abstract
Transcranial Doppler US, a non-invasive tool for evaluating the cerebral arteries, has evolved significantly during the last two decades. This review describes the practical procedure, and summarises and illustrates its established and "work-in-progress" indications in children. Indications for a transcranial Doppler US examination include, but are not limited to: (1) evaluation of cerebral blood flow velocities in the circle of Willis in patients with sickle cell anaemia to guide transfusion therapy; (2) diagnosis and follow-up of vasculopathy, such as moyamoya disease; (3) diagnosis and monitoring of acute cerebrovascular disorders in intensive care patients, in particular following traumatic brain injury, and during cardiovascular surgery; and (4) confirmation of a clinical diagnosis of brain death by documentation of cerebral circulatory arrest.
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Affiliation(s)
- Suzanne Verlhac
- Paediatric Imaging Department of G Sebag, Robert Debre Hospital, 48 boulevard Serurier, 75935 Paris Cedex 19, France.
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20
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Non-invasive imaging of intracranial pediatric vascular lesions. Childs Nerv Syst 2010; 26:1275-95. [PMID: 20596870 DOI: 10.1007/s00381-010-1203-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The goal of this review is to discuss the different non-invasive imaging techniques as well as the age-specific pediatric vascular pathologies and their imaging features. MATERIAL AND METHODS Ultrasound, computed tomography, and magnetic resonance imaging features of pediatric ischemic stroke, intracranial hemorrhage, aneurysms, cavernomas, developmental venous anomalies, and arteriovenous malformations are presented. In addition, multiple non-invasive angiographic techniques (CT and MR angiography) and functional MRI sequences (diffusion, perfusion, and susceptibility-weighted imaging) are discussed. CONCLUSION Neurovascular imaging plays a central role in the early, sensitive, and specific diagnosis of pediatric intracranial vascular disorders. A detailed knowledge of the quality and exact angioarchitecture of pediatric vascular pathologies as well as their impact on the cerebral hemo-dynamics is essential to guide and monitor treatment options and to predict functional outcome.
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Abstract
We investigated the association of increased cerebral blood flow velocity with specific language abilities in children with sickle cell disease (SCD). Thirty-nine children ages 5 to 8 years old with high-risk genotypes of SCD underwent cognitive testing, which included tests of language skills, visual motor skills, and attention/working memory as part of a routine hematology health-maintenance visit. Transcranial Doppler (TCD) velocities were obtained from review of medical records, with the velocities that were in closest temporal proximity to the cognitive assessment used in the analysis. TCD velocities predicted scores on tests of syntactical skills, even when controlling for anemia severity. Semantic and phonological ability and other cognitive skills were not strongly related to TCD velocities. Elevated blood flow velocities in children with high-risk SCD may contribute to a specific language impairment or to a broader dysfunction of short-term and/or working memory. This study underscores the need for clinicians to monitor language skills of children with SCD who have elevated TCD velocities, as these cognitive abilities might be particularly sensitive to cerebrovascular disruption related to their disease.
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Abstract
PURPOSE Stroke and subclinical "silent infarcts" are major causes of morbidity in children with Sickle Cell Disease (SCD). Ischemic strokes are more common in younger children while hemorrhagic strokes are more frequent in adults. The goal of neuroimaging in acute stroke is to document whether the stroke is ischemic or hemorrhagic, to assess the extent of parenchymal abnormalities and to determine the presence of other cerebrovascular lesions. Computed Tomography (CT) is the primary modality for the assessment of acute stroke patients because of its 24/7 availability and ability to exclude hemorrhagic causes. Magnetic resonance imaging (MRI) and MR angiography (MRA) are recommended to determine precisely extent of infarction and detect cerebrovascular abnormalities. The goal of neuroimaging in patients with hemorrhagic stroke is to identify an arteriovenous malformation or aneurysm(s) amenable to surgery or catheter intervention.The risk of first stroke is very high in asymptomatic children with intracranial arterial mean velocities over 200 cm/s on transcranial Doppler (TCD) examination. The risk can be substantially reduced if chronic blood transfusions are timely implemented. Large cerebral vessel disease detected by TCD can be confirmed or excluded by MRI/MRA. Those with evidence of parenchymal and/or cerebrovascular lesions should be followed by preventive therapy. In patients with neurologic symptoms and negative MRI/MRA findings Positron Emission Tomography or single photon emission CT is recommended. There are no specific neuroimaging findings that suggest that blood transfusions can be safely halted in children with SCD.
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North K, Lowe LH. Modern Head Ultrasound: Normal Anatomy, Variants, and Pitfalls That May Simulate Disease. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cult.2009.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Soetaert AM, Lowe LH, Formen C. Pediatric Cranial Doppler Sonography in Children: Non-Sickle Cell Applications. Curr Probl Diagn Radiol 2009; 38:218-27. [DOI: 10.1067/j.cpradiol.2008.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Gulhane Military Medical School, Etlik, Ankara, Turkey.
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Neuroimaging of nonaccidental head trauma: pitfalls and controversies. Pediatr Radiol 2008; 38:827-38. [PMID: 18176805 DOI: 10.1007/s00247-007-0729-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/23/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
Abstract
Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma.
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Rigamonti A, Ackery A, Baker AJ. Transcranial Doppler monitoring in subarachnoid hemorrhage: a critical tool in critical care. Can J Anaesth 2008; 55:112-23. [PMID: 18245071 DOI: 10.1007/bf03016323] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To review the literature regarding the use of transcranial Doppler ultrasonography (TCD) for monitoring cerebral vasospasm following subarachnoid hemorrhage (SAH). SOURCE We searched Medline (1980 to August 2007) and Embase (1980 to August 2007) and reviewed all relevant manuscripts regarding TCD and SAH. PRINCIPAL FINDINGS Currently, the gold standard for vasospasm diagnosis is cerebral angiography, replaceable by computed tomography angiography, only when angiography is not available. Obviously, it is not feasible to perform such investigation as frequently as bedside clinical assessment. Repeated clinical assessments of a patient's neurological status carry the problem of detecting the clinical signs and symptoms of vasospasm, which occur only after vasospasm has already manifested its deleterious effects on the cerebral parenchyma. Transcranial Doppler ultrasonography is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular calibre. Transcranial Doppler ultrasonography can be useful pre-, intra- and post-operatively, while helping to recognize the development of cerebral vasospasm before the onset of its clinical effects. CONCLUSION Vasospasm following SAH is a very important source of morbidity and mortality. Too often, the first sign is a neurologic deficit, which may be too late to reverse. Transcranial Doppler ultrasonography assists in the clinical decision-making regarding further diagnostic evaluation and therapeutic interventions. When performed in isolation, the contribution of TCD to improving patient outcome has not been established. Nevertheless, TCD has become a regularly employed tool in neurocritical care and perioperative settings.
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Affiliation(s)
- Andrea Rigamonti
- Department of Anaesthesia, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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Epelman M, Daneman A, Blaser SI, Ortiz-Neira C, Konen O, Jarrín J, Navarro OM. Differential Diagnosis of Intracranial Cystic Lesions at Head US: Correlation with CT and MR Imaging. Radiographics 2006; 26:173-96. [PMID: 16418251 DOI: 10.1148/rg.261055033] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The differential diagnosis of intracranial cystic lesions at head ultrasonography (US) includes a broad spectrum of conditions: (a) normal variants, (b) developmental cystic lesions, (c) cysts due to perinatal injury, (d) vascular cystlike structures, (e) hemorrhagic cysts, and (f) infectious cysts. These lesions vary in prevalence from common (cavum of the septum pellucidum, subependymal cyst, choroid plexus cyst) to rare (vein of Galen malformation). US can provide important information about the anatomic location, size, and shape of the lesions as well as their mass effect on adjacent structures. Differential diagnosis may be difficult because there is substantial overlap of US features between many of these conditions. However, if careful attention is paid to the location and characteristics of the cyst, a more specific diagnosis may be suggested. Understanding the spectrum of appearances of the various intracranial cystic lesions at head US improves the diagnostic yield, enables one to understand their pathogenesis, and facilitates patient care.
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Affiliation(s)
- Monica Epelman
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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