Comparison between Brain Computed Tomography Scan and Transcranial Sonography to Evaluate Third Ventricle Width, Peri-Mesencephalic Cistern, and Sylvian Fissure in Traumatic Brain-Injured Patients.

Raphael A G Oliveira,Edson Bor-Seng-Shu,Wellingson Silva Paiva,Luiz Marcelo De Sá Malbouisson,Manuel Jacobsen Teixeira,Marcelo De Oliveira Lima

doi:10.3389/fneur.2017.00044

Raphael A G Oliveira, Edson Bor-Seng-Shu + Show 4 more

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Transcranial color-coded duplex sonography (TCCS) may help guide multimodal monitoring in the neurocritical setting. It may provide indirect information about intracranial hypertension, such as midline shift, third ventricle width, and peri-mesencephalic cistern obliteration. We aim to assess the agreement between brain computed tomography scan (CT scan) and TCCS in traumatic brain injury (TBI) patients. In this retrospective cross-sectional observational study, TCCS was performed within 6 h before a brain CT scan. Only the first CT and TCCS after ICU admission were included. The agreement between the CT scan and TCCS was assessed by Bland-Altman plots and evaluating the intraclass correlation coefficient. Overall, 15 consecutive patients were included (80% male, 42 ± 23 years of age, Glasgow Coma Score 5 [4,6]). The mean difference between the brain CT scan and TCCS in measuring the midline shift was 0.30 ± 2.1 mm (intraclass correlation coefficient: 0.93; p < 0.01). An excellent correlation was also observed between the methods in assessing the third ventricle width (intraclass correlation coefficient: 0.88; p < 0.01). Bland-Altman plots did not show any systematic bias in either agreement analysis. TCCS showed good accuracy in predicting non-compressed peri-mesencephalic cisterns (AUC: 0.83, 95% CI 0.46-1.0) and the presence of the Sylvian fissure (AUC: 0.91, 95% CI 0.73-1.0) on CT scan. TCCS is a promising tool and may be an alternative to CT scans for evaluating TBI patients.

Highlights

Severe traumatic brain injury (TBI) remains an important cause of death and severe disability in adults
Several authors demonstrated that midline structural displacement and hyperdense lesions could be accurately measured by transcranial color-coded sonography (TCCS) compared to brain computed tomography (CT) scanning in acute braininjured patients, with either intact skulls or decompressive craniectomy [7]
TCCS showed an excellent performance in predicting non-compressed peri-mesencephalic cisterns and the presence of the Sylvian fissure compared to brain CT scanning

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Introduction

Severe traumatic brain injury (TBI) remains an important cause of death and severe disability in adults. Serial computed tomography (CT) brain scan imaging plays a crucial role in monitoring patients and helping guide intensive care management in the acute TBI phase [1]. In addition to the identification of neurosurgical lesions, brain CT scanning provides important information about intracranial pressure features, such as midline structural shifts, peri-mesencephalic cisterns, and third ventricle widths [2]. In addition to brain CT scans, transcranial color-coded sonography (TCCS) has been commonly applied in neurocritical care scenarios as a valuable tool to monitor acute brain-injured patients because of its non-invasive feature and bedside application. Several authors demonstrated that midline structural displacement and hyperdense lesions could be accurately measured by TCCS compared to brain CT scanning in acute braininjured patients, with either intact skulls or decompressive craniectomy [7]

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