Transcranial Color-Coded Sonography With Angle Correction As a Screening Tool for Raised Intracranial Pressure

Area of Science:

• Neurocritical care
• Neurosonology
• Intracranial pressure monitoring

Background:

• Transcranial Doppler (TCD) is a noninvasive tool for assessing intracranial pressure (ICP).
• Insonation angle errors can affect TCD accuracy.
• Angle correction using transcranial color-coded sonography (TCCS) for ICP evaluation has not been previously reported.

Purpose of the Study:

• To evaluate the diagnostic accuracy of TCCS for detecting elevated ICP.
• To assess the impact of insonation angle correction on TCCS accuracy in ICP measurement.

Main Methods:

• Prospective diagnostic accuracy study in an academic neurocritical care unit.
• Consecutive adult patients with invasive ICP monitoring were included.
• TCCS was used to measure velocities (EDV, TAPV) and pulsatility index (PI) in middle cerebral arteries, with and without angle correction.

Main Results:

• Angle correction improved the area under the curve (AUC) for estimated ICP (ICPe) from 0.51 to 0.73.
• With angle correction, ICPe > 21 mm Hg showed 100% sensitivity and 30% specificity for ICP > 22 mm Hg.
• The AUC for PI also improved with angle correction (0.61 to 0.70).

Conclusions:

• Insonation angle correction enhances the accuracy of TCCS for detecting elevated ICP.
• TCCS with angle correction demonstrates high sensitivity, suitable for ICP screening.
• Specificity remains low, necessitating further investigation or complementary diagnostic methods.