Artikel
Image-guided transcranial doppler sonography – Improved non-invasive vasospasm monitoring?
Suche in Medline nach
Autoren
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Esther Prokesch
- Klinik für Neurochirurgie, Universitätsmedizin Mainz
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Axel Neulen
- Klinik für Neurochirurgie, Universitätsmedizin Mainz
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Christoph Richter
- Klinik für Neurochirurgie, Universitätsmedizin Mainz
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Christian Greke
- Klinik für Neurochirurgie, Universitätsmedizin Mainz
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Alf Giese
- Klinik für Neurochirurgie, Universitätsmedizin Mainz
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: Transcranial Doppler sonography (TCD) is commonly used for bedside vasospasm monitoring in patients after subarachnoid haemorrhage. However, the method exhibits a high intra- and inter-investigator variability and thus may lead to inconsistent results. The present study was made to test the hypothesis that image-guided TCD promotes reproducibility and integrity of TCD exams and thereby leads to more reliable results.
Method: The study was performed in a prospective manner. CT-A data obtained for reasons unrelated to this study were used. Iplan software (Brainlab AG, Germany) was used to project navigational trajectories to middle (MCA), anterior (ACA) and posterior cerebral artery (PCA). A 2 MHz Doppler probe (DWL Compumedics, Germany) was tracked by a Kolibri™ neuronavigation system (Brainlab AG, Germany) and the patient’s head was registered. The Doppler probe was positioned with the help of image guidance and Doppler signals were derived. Patients were examined daily using conventional TCD as well as image-guided TCD.
Results: 20 female and 4 male patients aged 24 to 77 years were included. Patients suffered of SAH Hunt & Hess grades between 1 and 5 and Fisher grades between 2 and 4. Overall, 255 image-guided and 148 conventional TCD exams were performed. For MCA, 503 of 510 segments (99%) were detected in image-guided exams, compared to 265 of 296 (90%) in conventional exams. This difference was even more pronounced for ACA (472/510 vs. 243/296 detected segments, 93% vs. 82%) and PCA (504/510 vs. 254/296 detected segments, 99% vs. 86%). 21 patients showed mean blood velocities of >120 cm/s in 50 exams, 9 patients of >160 cm/s in 20 exams, and 6 patients of >200 cm/s in 15 exams. 5 patients developed hemodynamically relevant vasospasms, 1 of which was only associated with significantly increasing flow velocities in image-guided TCD.
Conclusions: Image-guided TCD has the potential to improve reproducibility and integrity of TCD through higher reproducibility and completeness of exams and therefore more reliable results.
