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Perioperative Detection of Cerebral Fat Emboli From Bone Using High-Frequency Doppler Ultrasound
Anders Hagen Jarmund1, Steinar Kristiansen2, Martin Leth-Olsen1
1Department of Circulation and Medical Imaging (ISB), NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Ultrasound in Medicine & Biology
|October 22, 2024
Summary
Cerebral fat emboli, a serious condition, can be detected using a new Doppler ultrasound system. This monitoring tool identified bone marrow emboli during orthopedic surgery in pigs and infants undergoing sternotomy.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Fat embolism syndrome (FES) and cerebral fat emboli are rare but severe complications.
- Bone marrow emboli, a cause of FES, can be released during orthopedic procedures and surgery.
- High-intensity transient signals (HITS) on Doppler ultrasound are indicative of emboli.
Purpose of the Study:
- To investigate if intramedullary nailing in pigs and median sternotomy in human infants release bone marrow emboli.
- To determine if a novel cerebral Doppler ultrasound system (NeoDoppler) can detect these emboli.
- To characterize the intensity of HITS generated during these procedures.
Main Methods:
- Pigs underwent femoral nailing or bone marrow injection, monitored with cerebral Doppler.
- Histology confirmed cerebral emboli in pigs.
- NeoDoppler data from infants undergoing sternotomy were analyzed for comparison.
Main Results:
- Cerebral Doppler detected HITS in 45% of pigs during femoral nailing; 92% had bone marrow emboli on biopsy.
- Positive control pigs receiving bone marrow injections showed 100% HITS detection.
- Median sternotomy in infants increased embolic burden, with lower HITS intensity than in pigs.
Conclusions:
- High-frequency cerebral Doppler ultrasound is a valuable real-time perioperative monitoring tool.
- The system can detect emboli, but sensitivity and specificity for bone marrow emboli may be limited.
- Embolus detection is potentially size-dependent.
