Article
Image guidance to enhance reproducibility of transcranial Doppler sonography
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Authors
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A. Neulen
- Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz
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C. Greke
- Neurochirurgische Klinik der Universitätsmedizin Göttingen
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S.R. Kantelhardt
- Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz
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D. Wertheimer
- Neurozentrum der Schön Klinik Hamburg Eilbek
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A. Giese
- Neurochirurgische Klinik und Poliklinik der Universitätsmedizin Mainz
| Published: | June 4, 2012 |
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Outline
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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.
