Transcranial ultrasonography to detect intracranial pathology: A systematic review and meta‐analysis

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.

Aberration correction by polynomial approximation for synthetic aperture ultrasound imaging

“…The proposed technique has significant relevance to current practices in transcranial ultrasound imaging, as it has the potential to enhance diagnostic capabilities for a range of conditions including tumors, intracranial hemorrhage,subdural hemorrhage,cerebral edema, hydrocephalus, and neurodegenerative diseases. 43 The estimated distortion curves can be utilized to correct Doppler ultrasound data, particularly in spectral pulsewave Doppler mode, which can help in the diagnosis of cerebral vascular diseases. 44,45 It is important to note that while the research was conducted using a Sonomed-500 ultrasound scanner in a single experimental setting, the proposed aberration correction approach is also compatible with other ultrasound machines capable of operating in synthetic aperture mode.…”

“…Therefore, its application is primarily beneficial for imaging static structures, such as ultrasound breast exams and certain instances of ultrasound mammography. The proposed technique has significant relevance to current practices in transcranial ultrasound imaging, as it has the potential to enhance diagnostic capabilities for a range of conditions including tumors, intracranial hemorrhage, subdural hemorrhage, cerebral edema, hydrocephalus, and neurodegenerative diseases 43 . The estimated distortion curves can be utilized to correct Doppler ultrasound data, particularly in spectral pulse‐wave Doppler mode, which can help in the diagnosis of cerebral vascular diseases 44,45 …”

Brain injury mobile diagnostic system: Applications in civilian medical service and on the battlefield—General concept and medical aspects

“…It is also possible that multiplane imaging of deep brain structures will also help diagnose chronic diseases, such as Parkinson's disease, Wilson's disease, and other neurodegenerative diseases for which the ultrasound diagnostics are currently at the stage of standardization or analysis. 44 5 | SUMMARY…”