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Kaźmierski R. Brain injury mobile diagnostic system: Applications in civilian medical service and on the battlefield-General concept and medical aspects. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1598-1606. [PMID: 37702254 DOI: 10.1002/jcu.23545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
To present the concept of a portable ultrasound tomography device for diagnosing traumatic and vascular brain lesions. The device consisting of multiple transcranial ultrasound probes placed on the surface of the head, specifically but not exclusively in natural acoustic windows. An integral part of the mobile diagnostic system (MDS) is a decision support system based on artificial intelligence algorithms utilizing information from: head images, laboratory data, and assessment of the patient's clinical condition. The MDS can significantly reduce the time from stroke onset to rtPA therapy in civilian medical services and support therapeutic and evacuation strategies in instances of brain and skull trauma on the battlefield.
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Affiliation(s)
- Radosław Kaźmierski
- Department of Neurology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
- Department for Neurology, Poznan University of Medical Sciences, Poznan, Poland
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2
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Amer HA, El-Jaafary SIM, Sadek HMAEA, Fouad AM, Mohammed SS. Clinical and paraclinical predictors of early neurological deterioration and poor outcome in spontaneous intracerebral hemorrhage. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:74. [PMID: 37305215 PMCID: PMC10242586 DOI: 10.1186/s41983-023-00675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Spontaneous intracerebral hemorrhage (sICH) is the second most common form of stroke. It is a major cause of morbidity and mortality. Several clinical and radiological parameters are related to its poor outcome. The aim of this study is to elucidate the clinical, laboratory, and radiological factors associated with early neurological deterioration and poor outcome in patients with ICH. Results seventy patients diagnosed with sICH were evaluated within the first 72 h from the onset of symptoms by Clinical, radiological, and laboratory parameters. Patients were assessed for early neurological deterioration (END) during the hospital stay (up to 7 days from admission) using Glasgow coma scale (GSC), and the National Institutes of Health Stroke Scale (NIHSS), and within 3 months from stroke onset using modified Rankin scale (mRS). ICH score and Functional Outcome in Patients with Primary Intracerebral Hemorrhage (FUNC) Score were calculated for prognostication. 27.1% and 71.42% of patients had END and showed unfavorable outcome, respectively. Clinical indices, as NIHSS > 7 on admission and age > 51 years, radiological characteristics, as large hematoma size, leukoaraiosis, and mass effect detected on CT scan, as well as serum biomarkers; serum urea level > 50 mg/dL, high neutrophil:lymphocyte ratio on admission, high ALT and AST, as well as low total, LDL, and HDL cholesterol levels, all were significantly associated with poor outcome in the patients. Stepwise multivariate logistic regression analysis found the presence of aspiration to be an independent predictor of END, and the scores of NIHSS > 7 on admission, age > 51 years, and urea level > 50 mg/dL were independent predictors of poor outcome. Conclusions There are several predictors for END as well as poor outcome in ICH. Some are clinical, others are radiological and laboratory. Aspiration was an independent predictor of END during hospital stay (3-7 days) in patients with ICH, while older age, high NIHSS and urea level on admission were independent predictors of poor outcome.
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Affiliation(s)
| | | | | | - Amr Mohamed Fouad
- Neurology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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3
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Lee RP, Antar A, Guryildirim M, Brem H, Luciano M, Huang J. Establishing proof of concept for sonolucent cranioplasty and point of care ultrasound imaging after posterior fossa decompression for Chiari malformation. J Clin Neurosci 2023; 113:38-44. [PMID: 37167829 DOI: 10.1016/j.jocn.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Evaluation after posterior fossa decompression for Chiari malformation can require repeated imaging, particularly with persistent symptoms. Typically, CT or MRI is used. However, CT carries radiation risk and MRI is costly. Ultrasound is an inexpensive, radiation-free, point-of-care modality that has, thus far, been limited by intact skull and traditional cranioplasty materials. Ultrasound also allows for imaging in different head positions and body postures, which may lend insight into cause for persistent symptoms despite adequate decompression on traditional neutral static CT or MRI. We evaluate safety and feasibility of ultrasound as a post-operative imaging modality in patients reconstructed with sonolucent cranioplasty during posterior fossa decompression for Chiari malformation. METHODS Outcomes were analyzed for 26 consecutive patients treated with a Chiari-specific sonolucent cranioplasty. This included infection, need for revision, CSF leak, and pseudomeningocele. Ultrasound was performed point-of-care in the outpatient clinic by the neurosurgery team to assess feasibility. RESULTS In eight months mean follow up, there were no surgical site infections or revisions with this novel sonolucent cranioplasty. Posterior fossa anatomy was discernable via transcutaneous ultrasound obtained point-of-care in the clinic setting at follow up visits. CONCLUSION We demonstrate proof of concept for ultrasound as a post-operative imaging modality after posterior fossa decompression for Chiari malformation. With further investigation, ultrasound may prove to serve as an alternative to CT and MRI in this patient population, or as an adjunct to provide positional and dynamic information. Use of sonolucent cranioplasty is safe. This technique deserves further study.
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Affiliation(s)
- Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert Antar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melike Guryildirim
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Lee RP, Meggyesy M, Ahn J, Ritter C, Suk I, Machnitz AJ, Huang J, Gordon C, Brem H, Luciano M. First Experience With Postoperative Transcranial Ultrasound Through Sonolucent Burr Hole Covers in Adult Hydrocephalus Patients. Neurosurgery 2023; 92:382-390. [PMID: 36637272 PMCID: PMC10553054 DOI: 10.1227/neu.0000000000002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly. Ultrasound is a radiation-free, relatively inexpensive, and optionally point-of-care alternative, but is prohibited by very limited windows through an intact skull. OBJECTIVE To describe our initial experience with transcutaneous transcranial ultrasound through sonolucent burr hole covers in postoperative hydrocephalus and CSF disorder patients. METHODS Using cohort study design, infection and revision rates were compared between patients who underwent sonolucent burr hole cover placement during new ventriculoperitoneal shunt placement and endoscopic third ventriculostomy over the 1-year study time period and controls from the period 1 year before. Postoperatively, trans-burr hole ultrasound was performed in the clinic, at bedside inpatient, and in the radiology suite to assess ventricular anatomy. RESULTS Thirty-seven patients with sonolucent burr hole cover were compared with 57 historical control patients. There was no statistically significant difference in infection rates between the sonolucent burr hole cover group (1/37, 2.7%) and the control group (0/57, P = .394). Revision rates were 13.5% vs 15.8% (P = 1.000), but no revisions were related to the burr hole or cranial hardware. CONCLUSION Trans-burr hole ultrasound is feasible for gross evaluation of ventricular caliber postoperatively in patients with sonolucent burr hole covers. There was no increase in infection rate or revision rate. This imaging technique may serve as an alternative to CT and MRI in the management of select patients with hydrocephalus and CSF disorders.
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Affiliation(s)
- Ryan P. Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Michael Meggyesy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Jheesoo Ahn
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Christina Ritter
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - A. Judit Machnitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Chad Gordon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
- Section of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
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5
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Allen BC, Kapoor S, Anzalone A, Mayer KP, Wolfe SQ, Duncan P, Asimos AW, D'Agostino R, Winslow JT, Sarwal A. Transcranial ultrasonography to detect intracranial pathology: A systematic review and meta-analysis. J Neuroimaging 2023; 33:333-358. [PMID: 36710079 DOI: 10.1111/jon.13087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Transcranial ultrasonography (TCU) can be a useful diagnostic tool in evaluating intracranial pathology in patients with limited or delayed access to routine neuroimaging in critical care or austere settings. We reviewed available literature investigating the diagnostic utility of TCU for detecting pediatric and adult patient's intracranial pathology in patients with intact skulls and reported diagnostic accuracy measures. METHODS We performed a systematic review of PubMed® , Cochrane Library, Embase® , Scopus® , Web of Science™, and Cumulative Index to Nursing and Allied Health Literature databases to identify articles evaluating ultrasound-based detection of intracranial pathology in comparison to routine imaging using broad Medical Subject Heading sets. Two independent reviewers reviewed the retrieved articles for bias using the Quality Assessment of Diagnostic Accuracy Studies tools and extracted measures of diagnostic accuracy and ultrasound parameters. Data were pooled using meta-analysis implementing a random-effects approach to examine the sensitivity, specificity, and accuracy of ultrasound-based diagnosis. RESULTS A total of 44 studies out of the 3432 articles screened met the eligibility criteria, totaling 2426 patients (Mean age: 60.1 ± 14.52 years). We found tumors, intracranial hemorrhage (ICH), and neurodegenerative diseases in the eligible studies. Sensitivity, specificity, and accuracy of TCU and their 95% confidence intervals were 0.80 (0.72, 0.89), 0.71 (0.59, 0.82), and 0.76 (0.71, 0.82) for neurodegenerative diseases; 0.88 (0.74, 1.02), 0.81 (0.50, 1.12), and 0.94 (0.92, 0.96) for ICH; and 0.97 (0.92, 1.03), 0.99 (0.96, 1.01), and 0.99 (0.97, 1.01) for intracranial masses. No studies reported ultrasound presets. CONCLUSIONS TCU has a reasonable sensitivity and specificity for detecting intracranial pathology involving ICH and tumors with clinical applications in remote locations or where standard imaging is unavailable. Future studies should investigate ultrasound parameters to enhance diagnostic accuracy in diagnosing intracranial pathology.
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Affiliation(s)
- Beddome C Allen
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sahil Kapoor
- Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Anthony Anzalone
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kirby P Mayer
- College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Stacey Q Wolfe
- Department of Neurosurgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Pam Duncan
- Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Andrew W Asimos
- Department of Emergency Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - James Tripp Winslow
- Department of Emergency Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Aarti Sarwal
- Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Valaikiene J, Schlachetzki F, Azevedo E, Kaps M, Lochner P, Katsanos AH, Walter U, Baracchini C, Bartels E, Školoudík D. Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:354-366. [PMID: 35512836 DOI: 10.1055/a-1816-8548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the last decade, ultrasound examination in neurology has been undergoing a significant expansion of its modalities. In parallel, there is an increasing demand for rapid and high-quality diagnostics in various acute diseases in the prehospital setting, the emergency room, intensive care unit, and during surgical or interventional procedures. Due to the growing need for rapid answers to clinical questions, there is particular demand for diagnostic ultrasound imaging. The Neuro-POCUS working group, a joint project by the European Academy of Neurology Scientific Panel Neurosonology, the European Society of Neurosonology and Cerebral Hemodynamics, and the European Reference Centers in Neurosonology (EAN SPN/ESNCH/ERcNsono Neuro-POCUS working group), was given the task of creating a concept for point-of-care ultrasound in neurology called "Neuro-POCUS". We introduce here a new ultrasound examination concept called point-of-care ultrasound in neurology (Neuro-POCUS) designed to streamline conclusive imaging outside of the ultrasound center, directly at the bedside. The aim of this study is to encourage neurologists to add quick and disease-oriented Neuro-POCUS to accompany the patient in the critical phase as an adjunct not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive neurosonology examination. Another goal is to avoid unwanted complications during imaging-free periods, ultimately resulting in advantages for the patient.
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Affiliation(s)
- Jurgita Valaikiene
- Center of Neurology, Clinic of Neurology and Neurosurgery, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, medbo Bezirksklinikum Regensburg, University of Regensburg, Germany
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manfred Kaps
- Neurology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Aristeidis H Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padova, Italy
| | - Eva Bartels
- Neurology, Center for Neurological Vascular Diagnostics, Munich, Germany
| | - David Školoudík
- Center for Health Research, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
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He L, Wu DF, Zhang JH, Zheng S, Li Y, He W. Factors affecting transtemporal window quality in transcranial sonography. Brain Behav 2022; 12:e2543. [PMID: 35238499 PMCID: PMC9015004 DOI: 10.1002/brb3.2543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/17/2022] [Accepted: 02/12/2022] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the influencing factors of transtemporal window quality and identify patients suitable for transcranial sonography (TCS) examination in two-dimensional imaging. METHODS In this cross-sectional study, TCS was performed in 161 consecutive patients through the temporal bone window (TBW) in the neurology or neurosurgery department. Each patient's sex, age, height, weight, and temporal bone thickness (TBT) were collected. After examination, the patients were divided into two groups: TBW success and TBW failure. The data were statistically compared between the two groups. RESULTS Among the studied population, the total TBW success rate was 80.1% (95% confidence interval [CI]: 74-86). The TBW success rate was 91.4% (95% CI: 85-98) in males and 70.9% (95% CI: 61-81) in females (p = .001). Sex (p = .001), age (p = .002), height (p = .047), and TBT (p < .001) showed significant differences between the TBW success and failure groups. In males, only TBT (p = .001) showed a significant difference; in females, age (p < .001) and TBT (p = .003) showed a significant difference. The area under the receiver operating characteristic curve (AUC) of sex, age, and TBT and their combination was 0.686, 0.659, 0.842, and 0.922 (p < .001), respectively. The AUC of the combination of parameters was significantly greater than that of age and sex alone (p = .007; p = .0002) but not greater than that of TBT (p = .090). CONCLUSIONS The TBW success rate varied with sex, age, height, and TBT. Males, younger patients, taller patients, and patients with a thinner temporal bone tended to be more suitable for the examination by TCS.
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Affiliation(s)
- Lei He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong-Fang Wu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing-Han Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lasselin P, Grousson S, Souza Netto EP, Balanca B, Terrier A, Dailler F, Haesbaert J, Boublay N, Gory B, Berhouma M, Lukaszewicz AC. Accuracy of bedside bidimensional transcranial ultrasound versus tomodensitometric measurement of the third ventricle. J Neuroimaging 2022; 32:629-637. [PMID: 35083801 PMCID: PMC9540242 DOI: 10.1111/jon.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the accuracy of transcranial duplex sonography (TCS) for measuring the diameter of the third ventricle (DTV) and the brain midline shift (MLS), as compared to cerebral CT. METHODS Single-center retrospective study including 177 patients admitted to the neurological intensive care unit (NICU). We studied the correlation between TCS and CT measurements of DTV and MLS using a Bland-Altman analysis. The best threshold of DTV to diagnose acute hydrocephalus was evaluated with a receiver operating characteristic (ROC) analysis. RESULTS We analyzed 177 pairs of CT-TCS measurements for DTV and 165 for MLS. The mean time interval between CT and TCS was 87 ± 73 minutes. Median DTV measurement on CT was 4 ± 3 mm, and 5 ± 3 mm by TCS. Median MLS on CT was 2 ± 3 mm, and 2 ± 4 mm by TCS. The Pearson correlation coefficient (r2 ) was .96 between TCS and CT measurements (p < .001). The Bland-Altman analysis found a proportional bias of 0.69 mm for the DTV with a limit of agreement ranging between -3.04 and 2.53 mm. For the MLS, the proportional bias was 0.23 mm with limits of agreements between -3.5 and 3.95. The area under the ROC curve was .97 for the detection of hydrocephalus by DTV on TCS, with a best threshold of 5.72 mm (Sensitivity [Se] = 92% Specificity [Sp] = 92.1%). CONCLUSIONS TCS seems to be a reliable and accurate bedside technique for measuring both DTV and MLS, which might allow detection of acute hydrocephalus among NICU patients.
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Affiliation(s)
- Philippe Lasselin
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Sebastien Grousson
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Anesthesia and Intensive Care, Paris Sud University, Le Kremlin-Bicêtre, France
| | | | - Baptiste Balanca
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Anne Terrier
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Frederic Dailler
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Julie Haesbaert
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Lyon, France
| | - Nawele Boublay
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Lyon, France
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Lyon University Hospital, Bron, France
| | - Moncef Berhouma
- Hospices Civils de Lyon, Department of Neurosurgery, Lyon University Hospital, Bron, France
| | - Anne-Claire Lukaszewicz
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France.,Université de Lyon EA 7426 Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France
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Gómez-de Frutos MC, García-Suárez I, Laso-García F, Diekhorst L, Otero-Ortega L, Alonso de Leciñana M, Fuentes B, Gutiérrez-Fernández M, Díez-Tejedor E, Ruíz-Ares G. B-Mode Ultrasound, a Reliable Tool for Monitoring Experimental Intracerebral Hemorrhage. Front Neurol 2022; 12:771402. [PMID: 35002926 PMCID: PMC8733327 DOI: 10.3389/fneur.2021.771402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) is currently used for the study of intracerebral hemorrhage (ICH) in animal models. However, ultrasound is an inexpensive, non-invasive and rapid technique that could facilitate the diagnosis and follow-up of ICH. This study aimed to evaluate the feasibility and reliability of B-mode ultrasound as an alternative tool for in vivo monitoring of ICH volume and brain structure displacement in an animal model. Methods: A total of 31 male and female Sprague-Dawley rats were subjected to an ICH model using collagenase-IV in the striatum following stereotaxic references. The animals were randomly allocated into 3 groups: healthy (n = 10), sham (n = 10) and ICH (n = 11). B-mode ultrasound studies with a 13-MHz probe were performed pre-ICH and at 5 h, 48 h, 4 d and 1 mo post-ICH for the assessment of ICH volume and displacement of brain structures, considering the distance between the subarachnoid cisterns and the dura mater. The same variables were studied by MRI at 48 h and 1 mo post-ICH. Results: Both imaging techniques showed excellent correlation in measuring ICH volume at 48 h (r = 0.905) and good at 1 mo (r = 0.656). An excellent correlation was also observed in the measured distance between the subarachnoid cisterns and the dura mater at 1 mo between B-mode ultrasound and MRI, on both the ipsilateral (r = 0.870) and contralateral (r = 0.906) sides of the lesion. Conclusion: B-mode ultrasound imaging appears to be a reliable tool for in vivo assessment of ICH volume and displacement of brain structures in animal models.
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Affiliation(s)
- Mari Carmen Gómez-de Frutos
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Iván García-Suárez
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Emergency Service, San Agustín Hospital, University of San Agustin, Asturias, Spain
| | - Fernando Laso-García
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luke Diekhorst
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Otero-Ortega
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Blanca Fuentes
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Gutiérrez-Fernández
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruíz-Ares
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, Neuroscience Area of IdiPAZ Health Research Institute, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Kapoor S, Offnick A, Allen B, Brown PA, Sachs JR, Gurcan MN, Pinton G, D'Agostino R, Bushnell C, Wolfe S, Duncan P, Asimos A, Sarwal A. Brain topography on adult ultrasound images: Techniques, interpretation, and image library. J Neuroimaging 2022; 32:1013-1026. [PMID: 35924877 PMCID: PMC9804536 DOI: 10.1111/jon.13031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Many studies have explored the possibility of using cranial ultrasound for discerning intracranial pathologies like tumors, hemorrhagic stroke, or subdural hemorrhage in clinical scenarios where computer tomography may not be accessible or feasible. The visualization of intracranial anatomy on B-mode ultrasound is challenging due to the presence of the skull that limits insonation to a few segments on the temporal bone that are thin enough to allow transcranial transmission of sound. Several artifacts are produced by hyperechoic signals inherent in brain and skull anatomy when images are created using temporal windows. METHODS While the literature has investigated the accuracy of diagnosis of intracranial pathology with ultrasound, we lack a reference source for images acquired on cranial topography on B-mode ultrasound to illustrate the appearance of normal and abnormal structures of the brain and skull. Two investigators underwent hands-on training in Cranial point-of-care ultrasound (c-POCUS) and acquired multiple images from each patient to obtain the most in-depth images of brain to investigate all visible anatomical structures and pathology within 24 hours of any CT/MRI imaging done. RESULTS Most reproducible structures visible on c-POCUS included bony parts and parenchymal structures. Transcranial and abdominal presets were equivalent in elucidating anatomical structures. Brain pathology like parenchymal hemorrhage, cerebral edema, and hydrocephalus were also visualized. CONCLUSIONS We present an illustrated anatomical atlas of cranial ultrasound B-mode images acquired in various pathologies in a critical care environment and compare our findings with published literature by performing a scoping review of literature on the subject.
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Affiliation(s)
- Sahil Kapoor
- Department of NeurologyWake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Austin Offnick
- Department of NeurologyWake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Beddome Allen
- Department of NeurologyWake Forest School of MedicineWinston‐SalemNCUSA
| | - Patrick A. Brown
- Departments of Radiology and NeurosurgeryWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jeffrey R. Sachs
- Neuroradiology Section, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Metin Nafi Gurcan
- Center for Biomedical InformaticsWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Gianmarco Pinton
- Joint Department of Biomedical EngineeringUniversity of North Carolina at Chapel Hill & North Carolina State UniversityChapel HillNorth CarolinaUSA
| | - Ralph D'Agostino
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Cheryl Bushnell
- Department of NeurologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Stacey Wolfe
- Department of NeurosurgeryWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Pam Duncan
- Department of NeurologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Andrew Asimos
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA,Carolinas Stroke NetworkAtrium HealthCharlotteNorth CarolinaUSA
| | - Aarti Sarwal
- Department of NeurologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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The Role of Ultrasound as a Diagnostic and Therapeutic Tool in Experimental Animal Models of Stroke: A Review. Biomedicines 2021; 9:biomedicines9111609. [PMID: 34829837 PMCID: PMC8615437 DOI: 10.3390/biomedicines9111609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
Ultrasound is a noninvasive technique that provides real-time imaging with excellent resolution, and several studies demonstrated the potential of ultrasound in acute ischemic stroke monitoring. However, only a few studies were performed using animal models, of which many showed ultrasound to be a safe and effective tool also in therapeutic applications. The full potential of ultrasound application in experimental stroke is yet to be explored to further determine the limitations of this technique and to ensure the accuracy of translational research. This review covers the current status of ultrasound applied to monitoring and treatment in experimental animal models of stroke and examines the safety, limitations, and future perspectives.
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Jiang C, Li Y, Xu K, Ta D. Full-Matrix Phase Shift Migration Method for Transcranial Ultrasonic Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:72-83. [PMID: 32795967 DOI: 10.1109/tuffc.2020.3016382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A spectrum-domain method, called full-matrix phase shift migration (FM-PSM), is presented for transcranial ultrasound phase correction and imaging with ideal synthetic aperture focusing technology. The simulated data obtained using the pseudospectral time-domain method are used to evaluate the feasibility of the method. The experimental data measured from a 3-D printed skull phantom are used to evaluate the algorithm performance in terms of resolution, contrast-to-noise ratio (CNR), and eccentricity comparing with the classical ray-tracing delay and sum (DAS) method. In wire imaging experiment, FM-PSM has a lateral resolution of 0.22 mm and ray-tracing DAS has a lateral resolution of 0.24 mm measured at -6-dB drop using a transducer with a center frequency of 6.25 MHz. In cylinder imaging experiment, FM-PSM has a CNR of 2.14 and ray-tracing DAS has a CNR of 1.82, which illustrates about 17% improvement. For a J -element array and an output image with pixels M ×N (lateral × axial), the computational cost of the DAS is of O(J ×M2×N2) ; on the contrary, it reduces to O(J ×M ×N2) with the proposed FM-PSM. The results suggest that FM-PSM is an efficiency method for transcranial ultrasonic imaging.
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Hakim SM, Abdellatif AA, Ali MI, Ammar MA. Reliability of transcranial sonography for assessment of brain midline shift in adult neurocritical patients: a systematic review and meta-analysis. Minerva Anestesiol 2020; 87:467-475. [PMID: 33054015 DOI: 10.23736/s0375-9393.20.14624-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis was to determine the reliability of transcranial sonography as an alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients. EVIDENCE AQUISITION The PubMed, EMBASE, Cochrane Library, Scopus and Web of Science databases were searched. Original studies evaluating brain midline shift in adult neurocritical patients using both transcranial sonography and computed tomography were eligible. Primary outcome measure was concordance between both methods as quantified in terms of concordance correlation coefficient. Secondary outcome measure was limits of agreement, defined as mean difference between sonography and computed tomography plus and minus 1.96 standard deviations. EVIDENCE SYNTHESIS Twelve studies (574 patients, 689 examinations) were eligible. Ten studies (416 patients, 492 examinations) provided adequate data for evaluation of concordance. Pooling of effect sizes showed strong concordance between both methods (concordance correlation coefficient, 0.91; 95% CI, 0.87 to 0.94). Two missing studies were imputed and effect size was adjusted to 0.88 (95% CI, 0.81 to 0.93). Nine studies (442 patients, 571 examinations) provided adequate data for estimation of limits of agreement. Pooling of effect sizes showed a bias of -0.53 mm (95% limits of agreement, -1.22 to 0.16 mm). Four missing studies were imputed and bias was adjusted to -0.68 mm (95% limits of agreement, -1.31 to -0.04 mm). CONCLUSIONS Transcranial sonography may serve as reliable alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients. Both methods have strong concordance with acceptably narrow limits of agreement.
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Affiliation(s)
- Sameh M Hakim
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt -
| | - Ayman A Abdellatif
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammad I Ali
- Department of Intensive Care, King Abdulaziz Hospital, Al-Jouf, Saudi Arabia
| | - Mona A Ammar
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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