Transcranial Duplex Sonography for Monitoring Hyperacute Intracerebral Hemorrhage

Abstract

Background and Purpose-Early hematoma growth is one of the main determinants of mortality in patients with intracranial hemorrhage (ICH). Transcranial duplex sonography (TDS) might represent a useful tool for the bedside monitoring of early ICH enlargement. We aimed to correlate ICH volumes measured by TDS and CT scan in patients with ICH evaluated Ͻ3 hours of symptom onset. Methods-We prospectively studied 34 patients with supratentorial ICH evaluated Ͻ3 hours of onset. All patients underwent emergent CT scan and TDS examination on admission and at 6 hours. Major longitudinal, sagittal, and coronal hematoma diameters were measured on CT scan by a neuroradiologist and on TDS by a blinded operator with a time delay Ͻ30 minutes between both techniques. Total hematoma volume was determined using the formula for irregular volumes (longitudinalϫsagittalϫcoronal)/2. Early hematoma growth was defined as an increase Ͼ20% in the hematoma volume at 6 hours. Results-ICH was identified on TDS as an hyperechogenic mass located in the basal ganglia in 28 patients and in the lobar position in 6. Mean hematoma volume at baseline was 86Ϯ4 5 mL. At 6 hours, early hematoma growth was seen in 9 (26%) patients.

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

“…The hematoma is often visualized through the contralateral bone window in reference to the hematoma location (73) (Figure 7). The volume of the hematoma is obtained by measuring the sagittal, transversal, and coronal diameter of the hematoma and then calculating the volume using the standard formula: ABC/2 (74, 75) (Figure 7). Studies indicate that TCDS is able to identify ICH with good sensitivity (73, 75–79).…”

“…The volume of the hematoma is obtained by measuring the sagittal, transversal, and coronal diameter of the hematoma and then calculating the volume using the standard formula: ABC/2 (74, 75) (Figure 7). Studies indicate that TCDS is able to identify ICH with good sensitivity (73, 75–79). TCDS is also able to estimate the diameters of the hematoma with systematic deviation close to zero (75, 76) and good volume estimation compared to CT (75–77).…”

Doppler Pulsatility Index in Spontaneous Intracerebral Hemorrhage

“…However, this involves the repeated transportation of critically ill, possibly ventilated and unstable patients, which may lead to complications in up to 70% [30]. Alternatively, intracranial MLS can be reliably monitored by TDS with a high inter- and intraobserver reliability [13,31,32], thus providing a noninvasive, bedside alternative to cCT. …”

“…Transcranial Doppler (TCD) and duplex sonography (TDS) present noninvasive, inexpensive bedside tools to diagnose and monitor intracranial pathology such as midline shift (MLS), cerebral artery flow velocities and, in special cases, hematoma volume [12,13,14,15] and is therefore applicable in patients with cerebral ischemia, subarachnoid hemorrhage and ICH [12,13,15,16,17,18]. Furthermore, elevated ICP may be detected by increased PI [19], which is not only more easily accessible than direct ICP measurement through ventriculostomy or microtransducers in the majority of patients but may also represent the ICP of a larger part of the supratentorial compartment due to the course of the respective intracranial vessel.…”

European Research Priorities for Intracerebral Haemorrhage

“…Alternative imaging tools, such as transcranial ultrasound, should be explored for early ICH diagnosis and non-invasive follow-up imaging [46]. Clinical grading scales predicting outcome after ICH could be improved by identifying the underlying cause and incorporating more specific imaging data [47].…”