gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Image guidance to enhance reproducibility of transcranial Doppler sonography

Meeting Abstract

  • A. Neulen - Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz
  • C. Greke - Neurochirurgische Klinik der Universitätsmedizin Göttingen
  • S.R. Kantelhardt - Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz
  • D. Wertheimer - Neurozentrum der Schön Klinik Hamburg Eilbek
  • A. Giese - Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.07.06

DOI: 10.3205/12dgnc062, URN: urn:nbn:de:0183-12dgnc0620

Published: June 4, 2012

© 2012 Neulen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Transcranial Doppler sonography (TCD), which is commonly used for monitoring of cerebral vasospasm after subarachnoid hemorrhage (SAH), has the disadvantage of rather high inter- and intrainvestigator variability. In the present study conventional TCD exams were followed with an image-guidance system. In a second setting image-guided TCD in the hands of TCD-unexperienced investigators was analyzed.

Methods: A 2 MHz Doppler probe (DWL Compumedics, Germany) was tracked by a Kolibri™ neuronavigation system (Brainlab AG, Germany). MR-A or CT-A data which had been obtained for reasons unrelated to the study were used to register the patient’s head. In a first setting the investigators had to label segments of intracranial vessels without access to the information provided by image guidance. Image-guidance was however used to track the effectively insonated vessels. In a second setting an experienced investigator defined trajectories leading to specific intracranial vessels by image guidance. A group of investigators without prior TCD experience then performed image-guided TCD. In both settings differences between labelling of vessels and effectively insonated vessels were analyzed.

Results: 174 vessel segments were labelled during 30 conventional TCD exams. Intraprocedural labelling matched the effectively insonated vessels in 109 cases (62.6%). Most frequent mislabelling included: internal carotid artery (ACI) as middle cerebral artery (ACM) (n = 12), posterior cerebral artery (ACP) as contralateral ACP (n = 12), ACI as anterior cerebral artery (ACA) (n = 8), ACP as ACM (n = 4), and ACP as ACA (n = 3). 5 unexperienced investigators performed image-guided TCD exams using predefined trajectories. In this series 29 of 30 vessel labels were labelled correctly.

Conclusions: The present study implies that a major cause of variability of TCD exams arises form difficulties in labelling of vessel segments. The use of image-guidance, providing anatomical orientation, enhances the precision of TCD and therefore provides the potential for higher standardization and precision of TCD exams rendering it a more a reliable diagnostic tool.