Reliability of transcranial sonography for assessment of brain midline shift in adult neurocritical patients: a systematic review and meta-analysis

Hakim, Sameh M.; Abdellatif, Ayman A; Ali, Mohammad; Ammar, Mona Ahmed

doi:10.23736/s0375-9393.20.14624-8

Cited by 11 publications

(3 citation statements)

References 34 publications

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“…akim et al investigated the concordance between transcranial sonography and cerebral computed tomography to detect brain midline shift in adult patients. 99 they concluded that sonography was reliable and offered the advantage of bedside, real-time evaluation.…”

Section: Neurocritical Carementioning

confidence: 99%

A year in review in Minerva Anestesiologica 2019. Critical care

et al. 2020

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Section: Neurocritical Carementioning

confidence: 99%

A year in review in Minerva Anestesiologica 2019. Critical care

et al. 2020

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“…There is also growing concern about the safety of techniques using ionizing radiation and this has bolstered interest in transcranial sonography (TCS) as an alternative to CT in certain clinical situations. 1 Trancranial sonography is a low cost, bedside examination which does not expose patients to ionizing radiation, and is currently used in several neurocritical care settings. Among potential applications of TCS is monitoring of ventriclular enlargement in patients at risk for hydrocephalus; however, pitfalls include interoperator and intraoperator reliability and occasional "window failure" which can make direct visualization of some structures difficult or even impossible.…”

mentioning

confidence: 99%

“…However, CT may be both time and resource consuming. There is also growing concern about the safety of techniques using ionizing radiation and this has bolstered interest in transcranial sonography (TCS) as an alternative to CT in certain clinical situations 1. Trancranial sonography is a low cost, bedside examination which does not expose patients to ionizing radiation, and is currently used in several neurocritical care settings.…”

mentioning

confidence: 99%

Reliability of Third Ventricle Assessment by Transcranial Ultrasound: A Computational Model of the Effect of Insonation Angle

Cassai

Geraldini

Calandra

et al. 2022

Journal of Neurosurgical Anesthesiology

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Introduction: Transcranial sonography (TCS) is a bedside examination which is currently used in multiple neurocritical care settings. Third ventricle ultrasound is usually a simple technique, though a large insonation angle could lead to an overestimation of third ventricular diameter. The aim of this study was to use a mathematical model to evaluate the impact of probe inclination on the false positive rate when using TCS to evaluate third ventricle enlargement.Methods: Using R software, we simulated a pool of 100,000 fictitious patients with a normal third ventricle size (diameter from 0 to 9 mm) in daily follow-up for ventricle enlargement for 30 consecutive days using TCS. Each day, a different, random insonation angle (α) was generated and a corresponding measured diameter calculated as: measured diameter = real diameter/cos α. If the measured diameter was > 9.0 mm, the simulation registered a "misdiagnosis" episode and the simulation loop was interrupted; otherwise, the simulation continued to its thirtieth iteration.Results: Of the 100,000 "patient" simulations, 30,905 (30.9%) had an erroneous TCS diagnosis of ventricular enlargement. Angles of insonation > 35 degrees contributed to 79.3% of the total misdiagnoses of ventricular enlargement (false positive rate, 3.71%), whereas misdiagnosis was rare when the insonation angle was ≤ 15 degrees (1.30% of the total misdiagnoses; false positive rate, 0.06%). Conclusion:Using probe inclinations <15 degrees, erroneous diagnosis of third ventricular enlargement was rare. Our results suggest that TCS has a low rate of false positives when the angle of insonation is minimized.

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