Methods Serial POCUS images were obtained from a hemicraniectomy patient and compared with near-concomitant computed tomography (CT) scans. The University of Cincinnati hemicraniectomy preset was created and optimized using a broadband sector array transducer with a 4–2 MHz operating frequency range. The depth and focus were set to visualize the brain tissue and contralateral bone. Imaging parameters were tested and saved for 2D grayscale mode, with an emphasis on tissue harmonic imaging, adaptive image processing, and dynamic range.

Bedside Cranial Ultrasonography in Patients with Hemicraniectomies: A Novel Window into Pathology.

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.

Brain topography on adult ultrasound images: Techniques, interpretation, and image library

The purpose of this paper is to provide an overview of the utility and indications of sonography in the Neuro ICU, with focus on recent studies and advances. Emerging data continue to shed light on the benefit of critical care sonography with neurovascular ultrasound being of particular interest in the Neuro ICU. Recent development of safe and feasible robotic TCDs holds promise in allowing continuous bedside monitoring of cerebrovascular hemodynamics, especially in conjunction with the use of automated software such as ICM+. Although newer and feasible methods for non-invasive measures of intracranial fluid and hemodynamics are rapidly emerging, use of neurovascular ultrasound remains limited due to lack of clinical and technical expertise. Recently published consensus statement on the recommended skills and competence level required to perform brain ultrasonography in the critical care setting may serve as a helpful framework to guide further training and protocol development. Utilization of systemic sonography has grown as a diagnostic and procedural aid in the critical care setting, while the rising body of literature continues to demonstrate the value of routine use of neurovascular ultrasound. Standardization of protocols and training paradigms could promote integration of this valuable tool in guiding management of brain injury patients.

Ultrasound-Guided Therapies in the Neuro ICU

Limited studies have evaluated the use of ultrasound for detection of intracerebral hemorrhage (ICH) using diagnostic ultrasound Transcranial Doppler machines in adults. The feasibility of ICH detection using Point of care Ultrasound (POCUS) machines has not been explored. We evaluated the feasibility of using cranial POCUS B mode imaging performed using intensive care unit (ICU) POCUS device for ICH detection with a secondary goal of mapping optimal imaging technique and brain topography likely to affect sensitivity and specificity of ICH detection with POCUS.After obtaining IRB approval, a blinded investigator performed cranial ultrasound (Fujifilm, Sonosite® Xporte, transcranial and abdominal presets) through temporal windows on 11 patients with intracerebral pathology within 72 h of last CT/MRI (computed tomography scan/magnetic resonance imaging) brain after being admitted to a neurocritical care unit in Aug 2020 and Nov 2020-Mar 2021. Images were then compared to patient's CT/MRI to inform topography. Inferential statistics were reported.Mean age was 57 (28-77 years) and 6/11 were female. Six patients were diagnosed with ICH, 3 with ischemic stroke, 1 subarachnoid hemorrhage, and 1 brain tumor. The sensitivity and specificity of point of care diagnosis of ICH compared to CT/MRI brain was 100% and 50%, respectively. Mean time between ultrasound scan and CT/MRI was 13.3 h (21 min-39 h). Falx cerebri, choroid calcification and midbrain-related artifacts were the most reproducible hyperechoic signals. Abdominal preset on high gain yielded less artifact than Transcranial Doppler preset for cranial B mode imaging. False positive ICH diagnosis was attributed to intracerebral tumor and midbrain-related artifact.Our exploratory analysis yielded preliminary data on use of point of care cranial ultrasound for ICH diagnosis to inform imaging techniques, cranial topography on B mode and sample size estimation for future studies to evaluate sensitivity and specificity of cranial POCUS in adult patients. This pilot study is limited by small sample size and over representation of ICH in the study. Cranial POCUS is feasible using POCUS machines and may have potential as a screening tool if validated in adequately powered studies. 

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Exploratory study to assess feasibility of intracerebral hemorrhage detection by point of care cranial ultrasound

Cranial Ultrasound

/pdf/intracranial-epidural-hematoma-follow-up-using-bidimensional-4ore7lwo4x.pdf

Leonardo Jorge Soares

Papers

Intracranial epidural hematoma follow-up using bidimensional ultrasound.