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Fattorello Salimbeni A, Kulyk C, Favruzzo F, De Rosa L, Viaro F, Pieroni A, Mozzetta S, Vosko MR, Baracchini C. Robotic Assisted Transcranial Doppler Monitoring in Acute Neurovascular Care: A Feasibility and Safety Study. Neurocrit Care 2025; 42:457-464. [PMID: 39300038 DOI: 10.1007/s12028-024-02121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Transcranial color Doppler (TCD) is currently the only noninvasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to evaluate the safety and feasibility of cerebral monitoring with a novel ra-TCD in acute neurovascular care. METHODS This is a two-center prospective study conducted between August 2021 and February 2022 at Padua University Hospital (Padua, Italy) and Kepler University Hospital (Linz, Austria). Adult patients with conditions impacting cerebral hemodynamics or patients undergoing invasive procedures affecting cerebral hemodynamics were recruited for prolonged monitoring (> 30 min) of the middle cerebral artery with a novel ra-TCD (NovaGuide Intelligent Ultrasound, NeuraSignal, Los Angeles, CA). Manual TCD was also performed for comparison by an experienced operator. Feasibility and safety rates were recorded. RESULTS A total of 92 patients (age: mean 68.5 years, range 36-91; sex: male 57 [62%]) were enrolled in the two centers: 54 in Padua, 38 in Linz. The examination was feasible in the majority of patients (85.9%); the head cradle design and its radiopacity hindered its use during carotid endarterectomy and mechanical thrombectomy. Regarding safety, only one patient (1.1%) reported a minor local edema due to prolonged probe pressure. Velocity values were similar between ra-TCD and manual TCD. CONCLUSIONS This novel ra-TCD showed an excellent safety and feasibility and proved to be as reliable as manual TCD in detecting blood flow velocities. These findings support its wider use for cerebral hemodynamics monitoring in acute neurovascular care. However, further technical improvements are needed to expand the range of applicable settings.
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Affiliation(s)
- Alvise Fattorello Salimbeni
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy.
| | - Caterina Kulyk
- Stroke Unit and Neurosonology Laboratory, Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Francesco Favruzzo
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Ludovica De Rosa
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Federica Viaro
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Alessio Pieroni
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Stefano Mozzetta
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Milan R Vosko
- Stroke Unit and Neurosonology Laboratory, Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
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Favilla CG, Baird GL, Grama K, Konecky S, Carter S, Smith W, Gitlevich R, Lebron-Cruz A, Yodh AG, McTaggart RA. Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke. J Neurointerv Surg 2025; 17:388-393. [PMID: 38514189 PMCID: PMC11415534 DOI: 10.1136/jnis-2024-021536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO. METHODS Patients were prospectively enrolled at two comprehensive stroke centers during stroke alert evaluation within 24 hours of onset with National Institutes of Health Stroke Scale (NIHSS) score ≥2. A 70 s bedside optical blood flow scan generated cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was determined by CT angiography. A deep learning model trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. Receiver operating characteristic (ROC) analysis compared the Openwater diagnostic performance (ie, LVO detection) with prehospital stroke scales. RESULTS Among 135 patients, 52 (39%) had an anterior circulation LVO. The median NIHSS score was 8 (IQR 4-14). The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The rapid arterial occlusion evaluation (RACE) scale had 60% sensitivity and 81% specificity and the Los Angeles motor scale (LAMS) had 50% sensitivity and 81% specificity. The binary Openwater classification (high-likelihood vs low-likelihood) had an area under the ROC (AUROC) of 0.82 (95% CI 0.75 to 0.88), which outperformed RACE (AUC 0.70; 95% CI 0.62 to 0.78; P=0.04) and LAMS (AUC 0.65; 95% CI 0.57 to 0.73; P=0.002). CONCLUSIONS The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients undergoing acute stroke evaluation in the emergency department. These encouraging findings need to be validated in an independent test set and the prehospital environment.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Grayson L Baird
- Department of Interventional Radiology, Brown University, Providence, Rhode Island, USA
| | | | | | - Sarah Carter
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Smith
- Department of Diagnostic Imaging, Lifespan Health System, Providence, Rhode Island, USA
| | - Rebecca Gitlevich
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexa Lebron-Cruz
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan A McTaggart
- Department of Interventional Radiology, Brown University, Providence, Rhode Island, USA
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Chang I, Pirahanchi Y, Izaguirre S, Rodriguez R, Wicknick A. Incorporation of robotic automated transcranial Doppler to screen for patent foramen ovale (PFO) and quantify right-to-left shunt severity in the evaluation of ischemic stroke patients for etiology and PFO management. Front Neurol 2025; 15:1481817. [PMID: 40017730 PMCID: PMC11866324 DOI: 10.3389/fneur.2024.1481817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/18/2024] [Indexed: 03/01/2025] Open
Abstract
Background Right-to-left shunt (RLS) associated with patent foramen ovale (PFO) is common among cryptogenic strokes. Current diagnostic tools have limitations. Transthoratic echocardiography (TTE) is not as sensitive as Transesophageal echocardiography (TEE), TEE is invasive, and manual transcranial Doppler (TCD) requires trained staff to operate. Robotic automated TCD (raTCD) may be feasible and comparable to manual TCD. The study's purpose was to determine the rate of RLS detection using raTCD and combine the Spencer Logarithmic Scale (SLS) with the Risk of Paradoxical Embolism (RoPE) to identify patients at risk of PFO associated stroke or TIA. Methods This single-center retrospective cohort study included adult patients (≥18 y/o) admitted from December 2021 to December 2022 with a stroke or transient ischemic attack. Those with no bone window or stroke mimics were excluded. Patients with an RLS on raTCD received a second scan at the physician's discretion. The SLS combined with the RoPE score was used to generate a modified screening PFO-Associated Stroke Causal Likelihood (msPASCAL) classification. Results Of 212 patients who received raTCD, the mean age was 56, 14% were >65 years old, most were white (72%), predominantly male (59%), 52% had cryptogenic strokes, and 59% had an RLS. Most patients were able to perform Valsalva (89%) during raTCD. Of those with an RLS, 56% had an SLS of 1-2, while 44% had an SLS of 3-5. There were no significant differences in characteristics by SLS. Most patients with SLS grades 1-2 were classified using msPASCAL as unlikely to have PFO as stroke etiology (n = 55, 44%). A small number of large SLS grades 3-5 were considered probable for having a PFO-associated stroke while the rest were classified as possible (n = 38, 30.4%). Eight patients with positive RLS on raTCD had a negative TTE with bubbles; most of those had small RLS on raTCD (n = 5, 63%) or could not Valsalva due to sedation ((n = 6, 75%). Discussion This study supports the feasibility of utilizing raTCD for RLS detection. The modified screening PASCAL classification can be generated for RLS patients and may be used to guide subsequent evaluation and management.
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Affiliation(s)
- Ira Chang
- Swedish Medical Center, Englewood, CO, United States
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Coudert A, Chavignon A, Denis L, Couture O. Volumetric Ultrasound Localization Microscopy With Diverging Cylindrical Waves. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:1657-1665. [PMID: 38466586 DOI: 10.1109/tuffc.2024.3375896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Transcranial ultrasound plays a limited role in neuroradiology due to its lack of resolution, planar imaging, and user dependency. By breaching the diffraction limit using injected microbubbles, volumetric ultrasound localization microscopy (ULM) could help alleviate those issues. However, performing 3-D ultrasound imaging at a high frame rate with sufficient signal-to-noise ratio (SNR) to track individual microbubbles through the skull remains a challenge, especially with a portable scanner. In this study, we describe a ULM sequence suitable for volumetric transcranial imaging exploiting cylindrical emissions on multiplexed matrix probes, through simulations, hydrophone measurements, and flow phantoms. This geometry leads to a doubling of the peak acoustic pressure, up to 400 kPa, with respect to spherical emission and improved volume rate, up to 180 Hz. Cylindrical emissions also improve the ULM saturation rate by 60% through a skull phantom. The assessment of microbubble velocity was also improved from a 33% error in the average flow measured with spherical waves to a 5% error with cylindrical waves. Conversely, we demonstrate the detrimental impacts of cylindrical waves toward the field of view and isotropic sensitivity. Nevertheless, due to its enhanced SNR and 3-D nature, such a cylindrical volumetric sequence could be beneficial for ULM as a diagnostic tool in humans, especially when portability is a necessity.
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Carvalho LB, Kaffenberger T, Chambers B, Borschmann K, Levi C, Churilov L, Thijs V, Bernhardt J. Cerebral hemodynamic response to upright position in acute ischemic stroke. Front Neurol 2024; 15:1392773. [PMID: 39055319 PMCID: PMC11269199 DOI: 10.3389/fneur.2024.1392773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Concerns exist that a potential mechanism for harm from upright activity (sitting, standing, and walking) early after an acute ischaemic stroke could be the reduction of cerebral perfusion during this critical phase. We aimed to estimate the effects of upright positions (sitting and standing) on cerebral hemodynamics within 48 h and later, 3-7 days post-stroke, in patients with strokes with and without occlusive disease and in controls. Methods We investigated MCAv using transcranial Doppler in 0° head position, then at 30°, 70°, 90° sitting, and 90° standing, at <48 h post-stroke, and later at 3-7 days post-stroke. Mixed-effect linear regression modeling was used to estimate differences in MCAv between the 0° and other positions and to compare MCAv changes across groups. Results A total of 42 stroke participants (anterior and posterior circulation) (13 with occlusive disease, 29 without) and 22 controls were recruited. Affected hemisphere MCAv decreased in strokes with occlusive disease (<48 h post-stroke): from 0° to 90° sitting (-9.9 cm/s, 95% CI[-16.4, -3.4]) and from 0° to 90° standing (-7.1 cm/s, 95%CI[-14.3, -0.01]). Affected hemisphere MCAv also decreased in strokes without occlusive disease: from 0° to 90° sitting (-3.3 cm/s, 95%CI[-5.6, -1.1]) and from 0° to 90° standing (-3.6 cm/s, 95%CI [-5.9, -1.3]) (p-value interaction stroke with vs. without occlusive disease = 0.07). A decrease in MCAv when upright was also observed in controls: from 0° to 90° sitting (-3.8 cm/s, 95%CI[-6.0, -1.63]) and from 0° to 90° standing (-3 cm/s, 95%CI[-5.2, -0.81]) (p-value interaction stroke vs. controls = 0.85). Subgroup analysis of anterior circulation stroke showed similar patterns of change in MCAv in the affected hemisphere, with a significant interaction between those with occlusive disease (n = 11) and those without (n = 26) (p = 0.02). Changes in MCAv from 0° to upright at <48 h post-stroke were similar to 3-7 days. No association between changes in MCAv at <48 h and the 30-day modified Rankin Scale was found. Discussion Moving to more upright positions <2 days post-stroke does reduce MCAv in the affected hemisphere; however, these changes were not significantly different for stroke participants (anterior and posterior circulation) with and without occlusive disease, nor for controls. The decrease in MCAv in anterior circulation stroke with occlusive disease significantly differed from without occlusive disease. However, the sample size was small, and more research is warranted to confirm these findings.
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Affiliation(s)
- Lilian B. Carvalho
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Tina Kaffenberger
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Brian Chambers
- Neurology Department, Austin Health, Melbourne, VIC, Australia
| | - Karen Borschmann
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Allied Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Christopher Levi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Neurology Department, Austin Health, Melbourne, VIC, Australia
| | - Julie Bernhardt
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
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Zuin M, De Vito A, Romagnoli T, Polastri M, Capatti E, Azzini C, Brombo G, Zuliani G. Cerebral Blood Flow in Alzheimer's Disease: A Meta-Analysis on Transcranial Doppler Investigations. Geriatrics (Basel) 2024; 9:58. [PMID: 38804315 PMCID: PMC11130854 DOI: 10.3390/geriatrics9030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cerebrovascular hemodynamic impairment has been reported in Alzheimer's disease (AD). We performed a systematic review and meta-analysis to investigate changes in cerebral blood flow (CBF) in AD patients. METHODS Data were obtained by searching MEDLINE and Scopus for all investigations published between 1 January 2011 and 1 November 2021, comparing the cerebrovascular hemodynamic between AD patients and cognately healthy age-matched controls, using transcranial Doppler (TCD) ultrasound. RESULTS Twelve studies, based on 685 patients [395 with AD and 290 age-matched cognitively healthy controls, with a mean age of 71.5 and 72.1 years, respectively] were included in the analysis. A random effect model revealed that AD patients, in the proximal segments of the middle cerebral artery (MCA), have a significantly lower CBF velocity, compared to controls (MD: -7.80 cm/s, 95%CI: -10.78 to -5.13, p < 0.0001, I2 = 71.0%). Due to a significant Egger's test (t = 3.12, p = 0.008), a trim-and-fill analysis was performed, confirming the difference (MD: -11.05 cm/s, 95%CI: -12.28 to -9.82, p < 0.0001). Meta-regression analysis demonstrated that the mean CBF at the proximal MCA was directly correlated with arterial hypertension (p = 0.03) and MMSE score (p < 0.001), but inversely correlated with age (p = 0.01). In AD patients, the pulsatility index was significantly higher compared to controls (MD: 0.16, 95%CI: 0.07 to 0.25, p < 0.0001, I2: 84.5%), while the breath-holding index test results were significant lower (MD: -1.72, 95%CI: -2.53 to -0.91, p < 0.001, I2: 85.4%). CONCLUSIONS AD patients have a significant impairment in relation to their cerebrovascular perfusion, suggesting that cerebrovascular hemodynamic deterioration, evaluated using TCD, may be a useful diagnostic tool.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Alessandro De Vito
- Department of Neurology, Stroke Division, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy;
| | - Tommaso Romagnoli
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Michele Polastri
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Eleonora Capatti
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Cristiano Azzini
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Gloria Brombo
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44124 Ferrara, Italy; (M.Z.); (T.R.); (M.P.); (E.C.); (C.A.); (G.B.)
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Zhou S, Gao X, Park G, Yang X, Qi B, Lin M, Huang H, Bian Y, Hu H, Chen X, Wu RS, Liu B, Yue W, Lu C, Wang R, Bheemreddy P, Qin S, Lam A, Wear KA, Andre M, Kistler EB, Newell DW, Xu S. Transcranial volumetric imaging using a conformal ultrasound patch. Nature 2024; 629:810-818. [PMID: 38778234 PMCID: PMC11875229 DOI: 10.1038/s41586-024-07381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
Accurate and continuous monitoring of cerebral blood flow is valuable for clinical neurocritical care and fundamental neurovascular research. Transcranial Doppler (TCD) ultrasonography is a widely used non-invasive method for evaluating cerebral blood flow1, but the conventional rigid design severely limits the measurement accuracy of the complex three-dimensional (3D) vascular networks and the practicality for prolonged recording2. Here we report a conformal ultrasound patch for hands-free volumetric imaging and continuous monitoring of cerebral blood flow. The 2 MHz ultrasound waves reduce the attenuation and phase aberration caused by the skull, and the copper mesh shielding layer provides conformal contact to the skin while improving the signal-to-noise ratio by 5 dB. Ultrafast ultrasound imaging based on diverging waves can accurately render the circle of Willis in 3D and minimize human errors during examinations. Focused ultrasound waves allow the recording of blood flow spectra at selected locations continuously. The high accuracy of the conformal ultrasound patch was confirmed in comparison with a conventional TCD probe on 36 participants, showing a mean difference and standard deviation of difference as -1.51 ± 4.34 cm s-1, -0.84 ± 3.06 cm s-1 and -0.50 ± 2.55 cm s-1 for peak systolic velocity, mean flow velocity, and end diastolic velocity, respectively. The measurement success rate was 70.6%, compared with 75.3% for a conventional TCD probe. Furthermore, we demonstrate continuous blood flow spectra during different interventions and identify cascades of intracranial B waves during drowsiness within 4 h of recording.
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Affiliation(s)
- Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Boyu Liu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Pranavi Bheemreddy
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Siyu Qin
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Arthur Lam
- Department of Anesthesiology and Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Keith A Wear
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Andre
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Erik B Kistler
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - David W Newell
- Department of Neurosurgery, Seattle Neuroscience Institute, Seattle, WA, USA
| | - Sheng Xu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, University of California San Diego, La Jolla, CA, USA.
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
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Duan J, Wang P, Wang H, Zhao W. Development of a prediction model for facilitating the clinical application of transcranial color-coded duplex ultrasonography. BMC Med Imaging 2024; 24:55. [PMID: 38443840 PMCID: PMC10913686 DOI: 10.1186/s12880-024-01233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Transcranial color-coded duplex ultrasonography (TCCD) is an important diagnostic tool in the investigation of cerebrovascular diseases. TCCD is often hampered by the temporal window that ultrasound cannot penetrate. Rapidly determine whether ultrasound can penetrate the temporal window in order to determine whether to use other acoustic windows to complete the examination process. In this study, Skull thickness can be measured simultaneously during TCCD examination, which makes it possible to use skull thickness to rapidly determine whether the temporal window is penetrated by ultrasound. METHODS This retrospective study included 301 patients with clinical symptoms of cerebrovascular diseases. These 301 patients were divided into an impenetrable temporal window (ITW) group and a penetrable temporal window group according to the results of the TCCD examination. RESULTS The area under the receiver operating characteristic (ROC) curve (AUC) for skull thickness was 0.887 (cutoff value 1.045 cm). Following multivariate logistic regression, sex, age, and skull thickness were used to develop a nomogram. The AUC for the nomogram was 0.923 (cutoff value 0.407). CONCLUSIONS The skull thickness at the temporal window was measured by ultrasound, which was convenient and accurate. The probability of ITW in females was higher than that in males, and it increased with age. In this study, a prediction model incorporating sex, age and skull thickness could predict ITW probability well. If the patient's temporal window was rapidly predicted as an ITW, other acoustic window examinations were used to complete the TCCD examination process to optimize the TCCD examination process of cerebrovascular diseases and facilitate the popularization of TCCD in clinical application.
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Affiliation(s)
- Jieyu Duan
- Department of Ultrasound, The First Hospital of Hebei Medicine University, 89 Donggang Road, Yuhua District, 050030, Shijiazhuang City, Hebei Province, China
| | - Pengfei Wang
- Department of neurosurgery, The Third Hospital of Hebei Medicine University, 050051, Shijiazhuang City, Hebei Province, China
| | - Haoyu Wang
- Department of Ultrasound, The First Hospital of Hebei Medicine University, 89 Donggang Road, Yuhua District, 050030, Shijiazhuang City, Hebei Province, China
| | - Wei Zhao
- Department of Ultrasound, The First Hospital of Hebei Medicine University, 89 Donggang Road, Yuhua District, 050030, Shijiazhuang City, Hebei Province, China.
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Favilla CG, Carter S, Hartl B, Gitlevich R, Mullen MT, Yodh AG, Baker WB, Konecky S. Validation of the Openwater wearable optical system: cerebral hemodynamic monitoring during a breath hold maneuver. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.11.23296612. [PMID: 37873126 PMCID: PMC10592983 DOI: 10.1101/2023.10.11.23296612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Bedside cerebral blood flow (CBF) monitoring has the potential to inform and improve care for acute neurologic diseases, but technical challenges limit the use of existing techniques in clinical practice. Here we validate the Openwater optical system, a novel wearable headset that uses laser speckle contrast to monitor microvascular hemodynamics. We monitored 25 healthy adults with the Openwater system and concurrent transcranial Doppler (TCD) while performing a breath-hold maneuver to increase CBF. Relative blood flow (rBF) was derived from the changes in speckle contrast, and relative blood volume (rBV) was derived from the changes in speckle average intensity. A strong correlation was observed between beat-to-beat optical rBF and TCD-measured cerebral blood flow velocity (CBFv), R=0.79; the slope of the linear fit indicates good agreement, 0.87 (95% CI:0.83-0.92). Beat-to-beat rBV and CBFv were strongly correlated, R=0.72, but as expected the two variables were not proportional; changes in rBV were smaller than CBFv changes, with linear fit slope of 0.18 (95% CI:0.17-0.19). Further, strong agreement was found between rBF and CBFv waveform morphology and related metrics. This first in vivo validation of the Openwater optical system highlights its potential as a cerebral hemodynamic monitor, but additional validation is needed in disease states.
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Vienneau EP, Byram BC. A Coded Excitation Framework for High SNR Transcranial Ultrasound Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2886-2898. [PMID: 37079411 PMCID: PMC10691235 DOI: 10.1109/tmi.2023.3269022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Robust transcranial ultrasound imaging is difficult due to poor image quality. In particular, low signal-to-noise ratio (SNR) limits sensitivity to blood flow and has hindered clinical translation of transcranial functional ultrasound neuroimaging thus far. In this work, we present a coded excitation framework to increase SNR in transcranial ultrasound without negatively impacting frame rate or image quality. We applied this coded excitation framework in phantom imaging and showed SNR gains as large as 24.78 dB and signal-to-clutter ratio gains as high as 10.66 dB with a 65 bit code. We also analyzed how imaging sequence parameters can impact image quality and showed how coded excitation sequences can be designed to maximize image quality for a given application. In particular, we show that considering the number of active transmit elements and the transmit voltage is critical for coded excitation with long codes. Finally, we applied our coded excitation technique in transcranial imaging of ten adult subjects and showed an average SNR gain of 17.91 ± 0.96 dB without a significant increase in clutter using a 65 bit code. We also performed transcranial power Doppler imaging in three adult subjects and showed contrast and contrast-to-noise ratio improvements of 27.32 ± 8.08 dB and 7.25 ± 1.61 dB, respectively with a 65 bit code. These results show that transcranial functional ultrasound neuroimaging may be possible using coded excitation.
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11
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Lee RP, Antar A, Guryildirim M, Brem H, Luciano M, Huang J. Establishing proof of concept for sonolucent cranioplasty and point of care ultrasound imaging after posterior fossa decompression for Chiari malformation. J Clin Neurosci 2023; 113:38-44. [PMID: 37167829 DOI: 10.1016/j.jocn.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Evaluation after posterior fossa decompression for Chiari malformation can require repeated imaging, particularly with persistent symptoms. Typically, CT or MRI is used. However, CT carries radiation risk and MRI is costly. Ultrasound is an inexpensive, radiation-free, point-of-care modality that has, thus far, been limited by intact skull and traditional cranioplasty materials. Ultrasound also allows for imaging in different head positions and body postures, which may lend insight into cause for persistent symptoms despite adequate decompression on traditional neutral static CT or MRI. We evaluate safety and feasibility of ultrasound as a post-operative imaging modality in patients reconstructed with sonolucent cranioplasty during posterior fossa decompression for Chiari malformation. METHODS Outcomes were analyzed for 26 consecutive patients treated with a Chiari-specific sonolucent cranioplasty. This included infection, need for revision, CSF leak, and pseudomeningocele. Ultrasound was performed point-of-care in the outpatient clinic by the neurosurgery team to assess feasibility. RESULTS In eight months mean follow up, there were no surgical site infections or revisions with this novel sonolucent cranioplasty. Posterior fossa anatomy was discernable via transcutaneous ultrasound obtained point-of-care in the clinic setting at follow up visits. CONCLUSION We demonstrate proof of concept for ultrasound as a post-operative imaging modality after posterior fossa decompression for Chiari malformation. With further investigation, ultrasound may prove to serve as an alternative to CT and MRI in this patient population, or as an adjunct to provide positional and dynamic information. Use of sonolucent cranioplasty is safe. This technique deserves further study.
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Affiliation(s)
- Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert Antar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melike Guryildirim
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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12
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Erkapic D, Aleksic M, Roussopoulos K, Weipert KF, Sözener K, Kostev K, Allendörfer J, Rosenbauer J, Guenduez D, Tanislav C. Microembolizations in the Arterial Cerebral Circulation in Patients with Atrial Fibrillation Ablation Using the Cryoballoon Technique-Protocol and Methodology of a Prospective Observational Study. Diagnostics (Basel) 2023; 13:diagnostics13091660. [PMID: 37175051 PMCID: PMC10178285 DOI: 10.3390/diagnostics13091660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
There is considerable uncertainty regarding the impact of microembolic signals (MESs) on neuropsychological abilities in patients receiving pulmonary vein isolation and beyond using the cryoballoon technique. We conducted the largest prospective observational study on this topic, providing insights into the gradual unmasking of procedure-related MESs and their impacts on neuropsychological outcomes. MESs were continuously detected periprocedurally using transcranial Doppler ultrasonography. Neuropsychological status was evaluated comprehensively using the CERAD Plus test battery, which consists of 11 neuropsychological subtests. Patients with atrial fibrillation were included in the study with an equal distribution (50:50) of paroxysmal or persistent presentations. Of 167 consecutive eligible patients, 100 were included within the study enrollment period from February 2021 to August 2022. The study, including the documentation of all follow-up visits, ended in November 2022. This paper focuses on describing the study protocol and methodology and presenting the baseline data.
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Affiliation(s)
- Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
- Department of Cardiology and Angiology, University Clinic of Giessen, 35392 Giessen, Germany
| | - Marko Aleksic
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
| | - Konstantinos Roussopoulos
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
| | - Kay Felix Weipert
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
| | - Korkut Sözener
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
- Department of Rhythmology, Klinikum Hanau, 63450 Hanau, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany
| | | | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
| | - Dursun Guenduez
- Department of Cardiology, Rhythmology and Angiology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
- Department of Cardiology and Angiology, University Clinic of Giessen, 35392 Giessen, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
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Ha MJ, Yu SH, Lee JH, Choi HJ, Kim BC. Usefulness of intraoperative transcranial sonography in patients with traumatic brain injuries: a comparison with postoperative computed tomography. JOURNAL OF TRAUMA AND INJURY 2023; 36:8-14. [PMID: 39381676 PMCID: PMC11309216 DOI: 10.20408/jti.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of this study was to assess the agreement between intraoperative transcranial sonography (TCS) and postoperative computed tomography (CT) in patients with traumatic brain injuries. Methods We performed a retrospective cross-sectional study of 35 patients who underwent TCS during surgery, among those who presented to a regional trauma center and underwent decompressive craniectomy between January 1, 2017 and April 30, 2020. Results The mean difference between TCS and CT in measuring the midline shift was -1.33 mm (95% confidence interval, -2.00 to -0.65; intraclass correlation coefficient [ICC], 0.96; P<0.001). An excellent correlation was found between TCS and CT in assessing contralateral subdural hematomas (ICC, 0.96; P<0.001) and focal hematoma lesions (ICC, 0.99; P<0.001). A very good correlation between TCS and CT was found for measurements of ventricle width (ICC, 0.92; P<0.001). Conclusions TCS during surgery is considered an effective diagnostic tool for the detection of intraoperative parenchymal changes in patients with traumatic brain injuries.
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Affiliation(s)
- Mahn Jeong Ha
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Han Yu
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Hwan Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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14
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Lee RP, Meggyesy M, Ahn J, Ritter C, Suk I, Machnitz AJ, Huang J, Gordon C, Brem H, Luciano M. First Experience With Postoperative Transcranial Ultrasound Through Sonolucent Burr Hole Covers in Adult Hydrocephalus Patients. Neurosurgery 2023; 92:382-390. [PMID: 36637272 PMCID: PMC10553054 DOI: 10.1227/neu.0000000000002221] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly. Ultrasound is a radiation-free, relatively inexpensive, and optionally point-of-care alternative, but is prohibited by very limited windows through an intact skull. OBJECTIVE To describe our initial experience with transcutaneous transcranial ultrasound through sonolucent burr hole covers in postoperative hydrocephalus and CSF disorder patients. METHODS Using cohort study design, infection and revision rates were compared between patients who underwent sonolucent burr hole cover placement during new ventriculoperitoneal shunt placement and endoscopic third ventriculostomy over the 1-year study time period and controls from the period 1 year before. Postoperatively, trans-burr hole ultrasound was performed in the clinic, at bedside inpatient, and in the radiology suite to assess ventricular anatomy. RESULTS Thirty-seven patients with sonolucent burr hole cover were compared with 57 historical control patients. There was no statistically significant difference in infection rates between the sonolucent burr hole cover group (1/37, 2.7%) and the control group (0/57, P = .394). Revision rates were 13.5% vs 15.8% (P = 1.000), but no revisions were related to the burr hole or cranial hardware. CONCLUSION Trans-burr hole ultrasound is feasible for gross evaluation of ventricular caliber postoperatively in patients with sonolucent burr hole covers. There was no increase in infection rate or revision rate. This imaging technique may serve as an alternative to CT and MRI in the management of select patients with hydrocephalus and CSF disorders.
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Affiliation(s)
- Ryan P. Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Michael Meggyesy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Jheesoo Ahn
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Christina Ritter
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - A. Judit Machnitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Chad Gordon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
- Section of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
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15
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Chan MYM, Ling YT, Chen XY, Chan ST, Kwong KK, Zheng YP. Success Rate of Transcranial Doppler Scanning of Cerebral Arteries at Different Transtemporal Windows in Healthy Elderly Individuals. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:588-598. [PMID: 36400675 DOI: 10.1016/j.ultrasmedbio.2022.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
This study measured the rates of success in applying transcranial Doppler (TCD) scanning at the middle, posterior and anterior temporal windows (MTW, PTW and ATW) in the elderly. A hand-held 1.6-MHz pulsed-wave TCD transducer was used to search for cerebral arteries at MTW, PTW and ATW locations. Physical attributes of the head, including head circumference and the distance between tragi on both sides ("tragus-to-tragus arc length"), were also measured to explore the associations with successful rates. Among 396 healthy elderly participants (aged 62.6 ± 6.0 y, 140 men), 81.1% (n = 321; 127 men) had one or more temporal windows penetrable by TCD ultrasound (n = 286 [72.2%] at MTW, n = 195 [49.2%] at PTW and n = 106 [26.8%] at ATW). Regression analysis revealed that successful scanning increased significantly in male participants at three window locations. Younger age significantly increased successful scanning at the MTW and ATW. Smaller tragus-to-tragus arc length increased successful scanning at the MTW, but unsuccessful scanning at the ATW. Our findings support using MTW as the first location when positioning the TCD transducer for the scanning of cerebral arteries in the elderly population. When performing TCD scanning on two temporal windows, we propose choosing the MTW and PTW.
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Affiliation(s)
- Mandy Yuen-Man Chan
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Yan To Ling
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Xiang-Yan Chen
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Smart Ageing, Hong Kong Polytechnic University, Hong Kong, China
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Kenneth K Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Smart Ageing, Hong Kong Polytechnic University, Hong Kong, China.
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16
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Favilla CG, Mullen MT, Kahn F, Rasheed IYD, Messe SR, Parthasarathy AB, Yodh AG. Dynamic cerebral autoregulation measured by diffuse correlation spectroscopy. J Cereb Blood Flow Metab 2023:271678X231153728. [PMID: 36703572 PMCID: PMC10369149 DOI: 10.1177/0271678x231153728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dynamic cerebral autoregulation (dCA) can be derived from spontaneous oscillations in arterial blood pressure (ABP) and cerebral blood flow (CBF). Transcranial Doppler (TCD) measures CBF-velocity and is commonly used to assess dCA. Diffuse correlation spectroscopy (DCS) is a promising optical technique for non-invasive CBF monitoring, so here we aimed to validate DCS as a tool for quantifying dCA. In 33 healthy adults and 17 acute ischemic stroke patients, resting-state hemodynamic were monitored simultaneously with high-speed (20 Hz) DCS and TCD. dCA parameters were calcaulated by a transfer function analysis using a Fourier decomposition of ABP and CBF (or CBF-velocity). Strong correlation was found between DCS and TCD measured gain (magnitude of regulation) in healthy volunteers (r = 0.73, p < 0.001) and stroke patients (r = 0.76, p = 0.003). DCS-gain retained strong test-retest reliability in both groups (ICC 0.87 and 0.82, respectively). DCS and TCD-derived phase (latency of regulation) did not significantly correlate in healthy volunteers (r = 0.12, p = 0.50) but moderately correlated in stroke patients (r = 0.65, p = 0.006). DCS-derived phase was reproducible in both groups (ICC 0.88 and 0.90, respectively). High-frequency DCS is a promising non-invasive bedside technique that can be leveraged to quantify dCA from resting-state data, but the discrepancy between TCD and DCS-derived phase requires further investigation.
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Affiliation(s)
| | - Michael T Mullen
- Department of Neurology, 6558Temple University, Philadelphia, USA
| | - Farhan Kahn
- Department of Neurology, 6572University of Pennsylvania, Philadelphia, USA
| | | | - Steven R Messe
- Department of Neurology, 6572University of Pennsylvania, Philadelphia, USA
| | | | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, USA
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17
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Panerai RB, Brassard P, Burma JS, Castro P, Claassen JA, van Lieshout JJ, Liu J, Lucas SJ, Minhas JS, Mitsis GD, Nogueira RC, Ogoh S, Payne SJ, Rickards CA, Robertson AD, Rodrigues GD, Smirl JD, Simpson DM. Transfer function analysis of dynamic cerebral autoregulation: A CARNet white paper 2022 update. J Cereb Blood Flow Metab 2023; 43:3-25. [PMID: 35962478 PMCID: PMC9875346 DOI: 10.1177/0271678x221119760] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cerebral autoregulation (CA) refers to the control of cerebral tissue blood flow (CBF) in response to changes in perfusion pressure. Due to the challenges of measuring intracranial pressure, CA is often described as the relationship between mean arterial pressure (MAP) and CBF. Dynamic CA (dCA) can be assessed using multiple techniques, with transfer function analysis (TFA) being the most common. A 2016 white paper by members of an international Cerebrovascular Research Network (CARNet) that is focused on CA strove to improve TFA standardization by way of introducing data acquisition, analysis, and reporting guidelines. Since then, additional evidence has allowed for the improvement and refinement of the original recommendations, as well as for the inclusion of new guidelines to reflect recent advances in the field. This second edition of the white paper contains more robust, evidence-based recommendations, which have been expanded to address current streams of inquiry, including optimizing MAP variability, acquiring CBF estimates from alternative methods, estimating alternative dCA metrics, and incorporating dCA quantification into clinical trials. Implementation of these new and revised recommendations is important to improve the reliability and reproducibility of dCA studies, and to facilitate inter-institutional collaboration and the comparison of results between studies.
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Affiliation(s)
- Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, and Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jurgen Ahr Claassen
- Department of Geriatric Medicine and Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Johannes J van Lieshout
- Department of Internal Medicine, Amsterdam, UMC, The Netherlands and Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, UK
| | - Jia Liu
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen University Town, Shenzhen, China
| | - Samuel Je Lucas
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Georgios D Mitsis
- Department of Bioengineering, McGill University, Montreal, Québec, QC, Canada
| | - Ricardo C Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei
| | - Caroline A Rickards
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Andrew D Robertson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Gabriel D Rodrigues
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jonathan D Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David M Simpson
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
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Yoo IH, Kim JM, Han SH, Ryu J, Jung KH, Park KY. Increased pulsatility index of the basilar artery is a risk factor for neurological deterioration after stroke: a case control study. Clin Hypertens 2022; 28:27. [PMID: 35965347 PMCID: PMC9377089 DOI: 10.1186/s40885-022-00210-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Higher pulsatility of the middle cerebral artery (MCA) is known to be associated with stroke progression. We investigated whether pulsatility index (PI) of the basilar artery (BA) can predict neurological deterioration (ND) after acute cerebral infarction. Methods A total of 708 consecutive patients with acute ischemic stroke who had undergone transcranial Doppler (TCD) ultrasonography were included. ND was defined as an increase in the National Institutes of Health Stroke Scale scores by two or more points after admission. The patients were categorized into quartiles according to BA PI. Multivariable logistic regression analysis was performed to examine whether BA PI is independently associated with ND. Results BA PI was well correlated with the right (n = 474, r2 = 0.573, P < 0.001) by Pearson correlation analysis although MCA PI could not be measured from right MCA (n = 234, 33.05%) and left MCA (n = 252, 35.59%) by TCD owing to insufficient temporal bone window. Multivariable logistic regression analysis including age, sex, cerebral atherosclerosis burden, National Institutes of Health Stroke Scale at admission, and the proportion of patients with current smoking status, hypertension, diabetes mellitus, atrial fibrillation revealed that the higher BA PI (odds ratio, 3.28; confidence interval, 1.07–10.17; P = 0.038) was independently associated with ND. Conclusions BA PI, which would be identified regardless of temporal window, could predict ND among acute stroke patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00210-9.
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Razumovsky AY, Jahangiri FR, Balzer J, Alexandrov AV. ASNM and ASN joint guidelines for transcranial Doppler ultrasonic monitoring: An update. J Neuroimaging 2022; 32:781-797. [PMID: 35589555 DOI: 10.1111/jon.13013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Today, it seems prudent to reconsider how ultrasound technology can be used for providing intraoperative neurophysiologic monitoring that will result in better patient outcomes and decreased length and cost of hospitalization. An extensive and rapidly growing literature suggests that the essential hemodynamic information provided by transcranial Doppler (TCD) ultrasonography neuromonitoring (TCDNM) would provide effective monitoring modality for improving outcomes after different types of vascular, neurosurgical, orthopedic, cardiovascular, and cardiothoracic surgeries and some endovascular interventional or diagnostic procedures, like cardiac catheterization or cerebral angiography. Understanding, avoiding, and preventing peri- or postoperative complications, including neurological deficits following abovementioned surgeries, endovascular intervention, or diagnostic procedures, represents an area of great public and economic benefit for society, especially considering the aging population. The American Society of Neurophysiologic Monitoring and American Society of Neuroimaging Guidelines Committees formed a joint task force and developed updated guidelines to assist in the use of TCDNM in the surgical and intensive care settings. Specifically, these guidelines define (1) the objectives of TCD monitoring; (2) the responsibilities and behaviors of the neurosonographer during monitoring; (3) instrumentation and acquisition parameters; (4) safety considerations; (5) contemporary rationale for TCDNM; (6) TCDNM perspectives; and (7) major recommendations.
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Affiliation(s)
| | | | - Jeffrey Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Kim M, Park SY, Hong JM. Simultaneous monitoring of the middle cerebral and basilar arteries to detect right-to-left shunts using transcranial Doppler by agitated saline administration. Sci Rep 2022; 12:6658. [PMID: 35459924 PMCID: PMC9033880 DOI: 10.1038/s41598-022-10645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Transcranial Doppler (TCD) is an easy, non-invasive, and real-time monitoring device for detecting right-to-left shunts (RLS). Nonetheless, it has limited benefits in patients with poor temporal windows. Therefore, we aimed to investigate whether the basilar artery (BA) window was as effective as the middle cerebral artery (MCA) in detecting RLS during TCD monitoring. Overall, we enrolled 344 patients with stroke, transient ischemic attack, headache, or dizziness. MCA and BA were monitored using a modified headset. To investigate the feasibility of the suboccipital window in detecting RLS, we instituted an evaluation tool with three tiers to evaluate microembolic signals (MESs) during TCD monitoring. Tier 1: TCD monitoring of the MCA (bilaterally) in the resting state, tier 2: TCD monitoring of the MCA (bilaterally) while performing the Valsalva maneuver, and tier 3: TCD monitoring of the index MCA and BA while performing the Valsalva maneuver. In tiers 2 and 3, a high agreement rate of 0.808 and 0.809 (p < 0.001), respectively, on the weighted kappa index, and a high intra-class correlation coefficient of 0.982 and 0.986 (p < 0.001), respectively, were observed on detecting MESs. Our data suggests that the BA window is as effective as the MCA window for detecting RLS on TCD.
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Affiliation(s)
- Min Kim
- Department of Neurology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - So Young Park
- Department of Neurology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Ji Man Hong
- Department of Neurology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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Transcranial Ultrasound as a Useful Tool in Early Detection and Follow-up of Hydrocephalus in Acute Subarachnoid Hemorrhage. J Neurosurg Anesthesiol 2022; 34:e75-e76. [PMID: 33136714 DOI: 10.1097/ana.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Comprehensive Evaluation of a Posterior Cerebral Artery Aneurysm and the Consequences of Rupture on Brain Tissue: The Value of Transcranial Color-Coded Duplex Ultrasonography. Neurocrit Care 2021; 36:317-322. [PMID: 34907477 DOI: 10.1007/s12028-021-01406-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
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Michimoto I, Miyashita K, Suzuyama H, Yano K, Kobayashi Y, Saito K, Matsukawa M. Simulation study on the effects of cancellous bone structure in the skull on ultrasonic wave propagation. Sci Rep 2021; 11:17592. [PMID: 34475422 PMCID: PMC8413454 DOI: 10.1038/s41598-021-96502-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
The transcranial Doppler method (TCD) enables the measurement of cerebral blood flow velocity and detection of emboli by applying an ultrasound probe to the temporal bone window, or the orbital or greater occipital foramina. TCD is widely used for evaluation of cerebral vasospasm after subarachnoid hemorrhage, early detection of patients with arterial stenosis, and the assessment of brain death. However, measurements often become difficult in older women. Among various factors contributing to this problem, we focused on the effect of the diploe in the skull bone on the penetration of ultrasound into the brain. In particular, the effect of the cancellous bone structure in the diploe was investigated. Using a 2D digital bone model, wave propagation through the skull bone was investigated using the finite-difference time-domain (FDTD) method. We fabricated digital bone models with similar structure but different BV/TV (bone volume/total volume) values in the diploe. At a BV/TV of approximately 50–60% (similar to that of older women), the minimum ultrasound amplitude was observed as a result of scattering and multiple reflections in the cancellous diploe. These results suggest that structural changes such as osteoporosis may be one factor hampering TCD measurements.
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Geraldini F, De Cassai A, Ciccarino P, Calabrese F, Chioffi F, Munari M. Ultrasound as a Useful Tool in Hydrocephalus Management During Pregnancy: A Case Report. A A Pract 2021; 15:e01451. [PMID: 33882035 DOI: 10.1213/xaa.0000000000001451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 38-year-old pregnant woman in her 24th week of gestation was admitted to our neurosurgical intensive care unit with a 5-cm cerebellar hemangioblastoma and acute hydrocephalus. Initial management included the placement of an external ventricular drain to prevent neurological deterioration. Five days after the initial diagnosis, the patient successfully underwent a neurosurgical intervention to remove the lesion. Transcranial ultrasound was used to determine the optimal ventricular drain level and facilitate weaning, bypassing the need for cerebral computed tomography and cerebral magnetic resonance imaging, which would have otherwise been necessary in postoperative follow-up.
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Affiliation(s)
| | | | | | | | | | - Marina Munari
- From the Department of Anesthesia and Intensive Care.,Department of Neuroanesthesia and Neurointensive Care, University-Hospital of Padua, Padua, Italy
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Brisson RT, Santos RDSA, Stefano LHSS, Barreira CMA, Arruda JFDL, Dias FA, Camilo MR, Pontes-Neto OM. Association between Tomographic Characteristics of the Temporal Bone and Transtemporal Window Quality on Transcranial Color Doppler Ultrasound in Patients with Stroke or Transient Ischemic Attack. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:511-516. [PMID: 33257102 DOI: 10.1016/j.ultrasmedbio.2020.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/09/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Transcranial color-coded Doppler (TCCD) is an ultrasonographic technique used to obtain and evaluate images of the cerebral parenchyma and to assess blood flow velocities of the intracranial vessels. One of the major limitations of TCCD is the failure to insonate through the transtemporal window, which occurs in about 5%-44% of patients. Temporal bone thickness has been strongly associated with transtemporal window failure (TWF). The aims of the study were to evaluate the association between TWF on TCCD and radiologic findings on computed tomography of the skull along with the demographic characteristics of patients with acute stroke or transient ischemic attack (TIA), and to propose a classification for transcranial window quality (TWQ) on B-mode scan of TCCD. A total of 187 consecutive patients with acute stroke or TIA were included. Among them, 21.9% had TWF and 34.8% had TWQ categorized as insufficient on B-mode scan of TCCD. On logistic regression, age (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.03-1.12, p < 0.001), female sex (OR = 5.99, 95% CI: 2.09-17.16, p = 0.001), pneumatized temporal bone (OR = 7.90, 95% CI: 1.95-32.03, p = 0.004) and temporal bone thickness (OR = 3.04, 95% CI: 1.73-5.35, p < 0.001) were independent predictors of TWF, even after adjusting for confounders. These findings may help to select patients in whom echogenic contrast or even other imaging methods could be used to assess intracranial vessels.
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Affiliation(s)
- Rodrigo Tavares Brisson
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Department of Neurology, Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil.
| | - Renata da Silva Almeida Santos
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Clara Monteiro Antunes Barreira
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Francisco Antunes Dias
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Millene Rodrigues Camilo
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Tian G, Ji Z, Lin Z, Pan S, Yin J. Cerebral autoregulation is heterogeneous in different stroke mechanism of ischemic stroke caused by intracranial atherosclerotic stenosis. Brain Behav 2021; 11:e01907. [PMID: 33095506 PMCID: PMC7821627 DOI: 10.1002/brb3.1907] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic stenosis (ICAS) is the most common cause of ischemic stroke (IS) and is associated with stroke recurrence. It results in IS due to a variety of mechanisms. However, the influence of brain reserve mechanism on different stroke mechanism is still unclear. Cerebral autoregulation (CA) is an important brain reserve mechanism and is impaired after IS. This study aimed to explore the impaired pattern of CA and assess the association between CA and stroke risk factors in different stroke mechanism caused by ICAS. METHODS IS patients with ICAS (50%-99% stenosis/occlusion) in middle cerebral artery (MCA) or internal carotid artery were enrolled to receive CA examinations within 7 days after onset. Healthy volunteers were also recruited as controls. CA was recorded from spontaneous fluctuations of blood pressure and MCA flow velocity. Transfer function analysis was used to derive CA parameters, including phase difference (PD) and coherence in the low-frequency range (0.06-0.12 Hz). RESULTS A total of 89 IS patients and 90 healthy controls were included. Compared with controls, CA was impaired ipsilaterally in patients with parent artery atherosclerosis occluding penetrating artery (POPA) while CA was bilaterally impaired in other stroke mechanisms. And CA on ipsilateral hemisphere was correlated with hypertension/hyperlipidemia in patients with POPA (r = -0.481, p = .008; r = -0.484, p = .008). While CA on ipsilateral hemisphere was correlated with perfusion parameter including the arterial spin-labeling (ASL) parameter cerebral blood flow (CBF) (r = 0.893, p = .007) and collateral circulation status the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) (r = 0.610, p = .021) in patients with hypoperfusion mechanism. CONCLUSION In IS patients, CA was impaired heterogeneously and was correlated with different risk factors in varied stroke mechanism. CA can be as an informative determinant of stroke risk in patients with ICAS and to help improving individualized treatment strategies in the presence of ischemic stroke caused by ICAS.
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Affiliation(s)
- Ge Tian
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Yin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Khan DZ, Placek MM, Smielewski P, Budohoski KP, Anwar F, Hutchinson PJA, Bance M, Czosnyka M, Helmy A. Robotic Semi-Automated Transcranial Doppler Assessment of Cerebrovascular Autoregulation in Post-Concussion Syndrome: Methodological Considerations. Neurotrauma Rep 2020; 1:218-231. [PMID: 33274347 PMCID: PMC7703686 DOI: 10.1089/neur.2020.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Post-concussion syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence and impact, the underlying mechanisms of PCS are unclear. We hypothesized that impaired cerebral autoregulation (CA) is a contributor. In this article, we present our protocol for non-invasively assessing CA in patients with TBI and PCS in a real-world clinical setting. A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical center. Data points included: demographics, symptom profile (Post-Concussion Symptom Scale [PCSS]) and neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]). Cerebrovascular metrics (nMxa co-efficient and the transient hyperaemic-response ratio [THRR]) were collected using transcranial Doppler (TCD), finger plethysmography, and bespoke software (ICM+). Twelve participants were initially recruited but 2 were excluded after unsuccessful insonation of the middle cerebral artery (MCA); 10 participants (5 patients with TBI, 5 healthy controls) were included in the analysis (median age 26.5 years, male to female ratio: 7:3). Median PCSS scores were 6/126 for the TBI patient sub-groups. Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). nMxa was calculated for 90% of included patients, whereas THRR was calculated for 50%. Median study time was 127.5 min and feedback (n = 6) highlighted the perceived acceptability of the study. This pilot study has demonstrated a reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. This protocol is feasible and is acceptable to participants. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI.
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Affiliation(s)
- Danyal Z Khan
- Division of Neurosurgery, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michal M Placek
- Brain Physics Laboratory, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Peter Smielewski
- Brain Physics Laboratory, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Karol P Budohoski
- Division of Neurosurgery, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Fahim Anwar
- Department of Neurorehabilitation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Peter J A Hutchinson
- Division of Neurosurgery, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manohar Bance
- Department of ENT, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Marek Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Adel Helmy
- Division of Neurosurgery, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Asquier N, Chapelon JY, Lafon C. Evaluation of the Uncertainty of Passive Cavitation Measurements for Blood-Brain Barrier Disruption Monitoring. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2736-2743. [PMID: 32653206 DOI: 10.1016/j.ultrasmedbio.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Exposure to ultrasound combined with intravenous injection of microbubbles is a technique that can be used to temporarily disrupt the blood-brain barrier. Transcranial monitoring of cavitation can be done with one or more passive cavitation detectors (PCDs). However, the positioning of the PCDs relative to the cavitation site and the attenuation of these signals by the skull are two sources of error in the quantification of cavitation activity. The aim of this study was to evaluate in vitro the amplitude variation of cavitation signals that can be expected for an excised porcine skull model. The variation caused by the relative positioning of the PCD with respect to the cavitation site was quantified. A position-based correction of the signal amplitude was evaluated. Pig skull samples were used to assess variation in signal amplitude caused by bone. The overall coefficient of variation of the signals owing to these measurement biases was estimated at 30.8%.
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Affiliation(s)
- Nicolas Asquier
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France.
| | - Jean-Yves Chapelon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
| | - Cyril Lafon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
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Neurovascular Dysfunction in Alzheimer Disease: Assessment of Cerebral Vasoreactivity by Ultrasound Techniques and Evaluation of Circulating Progenitor Cells and Inflammatory Markers. Alzheimer Dis Assoc Disord 2020; 33:212-219. [PMID: 31335454 DOI: 10.1097/wad.0000000000000331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS The aims of this study were to assess vascular dysfunction in patients with Alzheimer disease (AD) by investigating cerebral vasomotor reactivity using transcranial Doppler ultrasound (TCD) and to evaluate any correlations between cerebral vasoreactivity and endothelium dysfunction. Moreover, the frequency of circulating progenitor cells (CPCs) and the blood concentration of vascular/inflammatory markers were evaluated. MATERIALS AND METHODS We recruited 35 AD subjects and 17 age-matched, sex-matched, and education-matched healthy control subjects. Cerebral vasomotor reactivity was assessed by means of the TCD-based breath-holding index test (BHI). The level of CPCs was evaluated by means of flow cytometry from venous blood samples, while blood vascular/inflammatory markers were measured by means of enzyme-linked immunosorbent assay. RESULTS Both cerebral assay blood flow velocity in the middle cerebral artery (MCAFV) and BHI values were significantly lower in AD subjects than in healthy controls (P<0.05). A positive trend was found between MCAFV and BHI values and Mini-Mental State Evaluation (MMSE) scores. Moreover, the hematopoietic progenitor cells' count was found to be lower in patients with AD than in controls (P<0.05). Finally, a significantly higher expression of the plasma chemokine CCL-2 was observed in AD patients than in healthy controls. CONCLUSIONS Our results confirm that cerebral hemodynamic deterioration may be a critical marker of cognitive decline. Further studies are needed to investigate the role of circulating CPCs and chemokines as potential contributors to neurovascular dysfunction.
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Dynamic cerebral autoregulation is an independent outcome predictor of acute ischemic stroke after endovascular therapy. BMC Neurol 2020; 20:189. [PMID: 32414382 PMCID: PMC7227298 DOI: 10.1186/s12883-020-01737-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Endovascular therapy (EVT) is increasingly used to improve cerebral reperfusion after moderate-to-severe acute ischemic stroke (AIS). However, the influence of hemodynamic factors on clinical outcome is still unclear after EVT. Dynamic cerebral autoregulation (dCA) is an important brain reserve mechanism and is impaired after AIS. This study aimed to explore the role of dCA in predicting the outcome of AIS patients after EVT. Methods AIS patients with severe stenosis/occlusion of unilateral middle cerebral artery (MCA) or internal carotid and treatment with EVT were enrolled to receive dCA examinations at the 24 h, 72 h and 7th day after stroke onset. Healthy volunteers were also recruited as controls. DCA was recorded from spontaneous fluctuations of blood pressure and MCA flow velocity. Transfer function analysis was used to derive dCA parameters, including phase difference (PD) and coherence in the low-frequency range (0.06–0.12 Hz). The clinical outcome was measured using the modified Rankin Scale (mRS) at 90 days after onset. Multivariate logistic regression was performed to reveal the correlation between dCA and clinical outcomes. The receiver operation characteristics (ROC) curve was performed to determine the cut-off point of PD. Results A total of 62 AIS patients and 77 healthy controls were included. Compared with controls, dCA were impaired bilaterally till to 7th day after onset in patients, presenting as much lower PD value on the ipsilateral side. During follow-up, we found that PD on the ipsilateral side at 24 h after onset was significantly lower in patients with unfavourable outcome (n = 41) than those with favourable outcome (n = 21), even after adjustment of confounding factors (p = 0.009). ROC curve analysis revealed that PD < 26.93° was an independent predictor of unfavourable-outcome. Conclusion In AIS patients after EVT, dCA was impaired on both sides over the first 7 days. PD on the ipsilateral side at 24 h after onset is an independent unfavourable-outcome predictor for AIS after EVT.
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Factors associated with temporal window failure in transcranial Doppler sonography. Neurol Sci 2020; 41:3293-3299. [PMID: 32405883 DOI: 10.1007/s10072-020-04459-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Temporal window failure (TWF) is found in 8-20% of subjects. There are still insufficient studies about the factors affecting TWF. We aimed to elucidate the underlying causes of TWF. METHODS We analyzed 376 patients who underwent both transcranial Doppler sonography and cerebral angiographic imaging. They were divided into two groups: with and without TWF. Demographics, cardiovascular factors, degree of stenosis from the proximal intracranial artery to the middle cerebral artery (MCA), MCA diameter, and skull features were examined. RESULTS The subjects were 314 TWF-negative patients and 62 TWF-positive patients. The TWF-negative group was younger than that of the TWF-positive group (67.0 ± 12.1 vs. 75.2 ± 9.4, p < 0.001). The proportion of men in the TWF-negative group was higher than in the TWF-positive group (71% vs. 29%; p < 0.001). The TWF-negative group had a higher smoking rate than the TWF-positive group (34.4% vs. 12.9%; p = 0.001). In multivariate logistic regression analysis, age (odds ratio (OR), 1.05; p = 0.019), sex (OR, 4.64; p = 0.002), temporal bone thickness (OR, 6.03; p < 0.001), temporal bone density (OR, 0.996; p = 0.002), and soft tissue thickness (OR, 1.31; p = 0.004) significantly affected TWF. CONCLUSIONS In addition to age, sex, temporal bone thickness, and temporal bone density which were previously reported as variables associated with TWF, we confirmed that soft tissue thickness of the temporal area is a new associated factor of TWF. Measuring soft tissue thickness of the temporal area for patients with suspected TWF could be useful in identifying measurement error due to technical problems.
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Carvalho LB, Kramer S, Borschmann K, Chambers B, Thijs V, Bernhardt J. Cerebral haemodynamics with head position changes post-ischaemic stroke: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2020; 40:271678X20922457. [PMID: 32404023 PMCID: PMC7786838 DOI: 10.1177/0271678x20922457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/20/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Abstract
The effects of upright postures on the cerebral circulation early post-ischaemic stroke are not fully understood. We conducted a systematic review and meta-analysis to investigate the effects of head positioning on cerebral haemodynamics assessed by imaging methods post-ischaemic stroke. Of the 21 studies included (n = 529), 15 used transcranial Doppler. Others used near-infrared, diffuse correlation spectroscopy and nuclear medicine modalities. Most tested head positions between 0° and 45°. Seventeen studies reported changes in CBF parameters (increase at lying-flat or decrease at more upright) in the ischaemic hemisphere with position change. However, great variability was found and risk of bias was high in many studies. Pooled data of two studies ≤24 h (n = 28) showed a mean increase in cerebral blood flow (CBF) velocity of 8.5 cm/s in the ischaemic middle cerebral artery (95%CI,-2.2-19.3) from 30° to 0°. The increase found ≤48 h (n = 50) was of 2.3 cm/s (95%CI,-4.6-9.2), while ≤7 days (n = 38) was of 8.4 cm/s (95%CI, 1.8-15). Few very early studies (≤2 days) tested head positions greater than 30° and were unable to provide information about the response of acute stroke patients to upright postures (sitting, standing). These postures are part of current clinical practice and knowledge on their effects on cerebral haemodynamics is required.
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Affiliation(s)
- Lilian B Carvalho
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
| | - Sharon Kramer
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
- St Vincent’s Hospital, Melbourne, Australia
| | - Brian Chambers
- Department of Neurology, Austin Health, Heidelberg, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Vincent Thijs
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
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Association of Newly Found Asymptomatic Intracranial Artery Stenosis and Ideal Cardiovascular Health Metrics in Chinese Community Population. Sci Rep 2020; 10:7200. [PMID: 32350306 PMCID: PMC7190703 DOI: 10.1038/s41598-020-63927-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/25/2020] [Indexed: 12/28/2022] Open
Abstract
In the general population, there is a strong inverse relationship between the number of ideal cardiovascular health (CVH) metrics and the total incidence of cardiovascular diseases and stroke. However, the prevalence of ideal CVH is extremely low and there are few studies on its association with newly found asymptomatic intracranial arterial stenosis (AICAS). Therefore, we performed this prospective study to assess the relationship between the newly found AICAS and ideal CVH metrics in the Chinese community population. Seven ideal CVH metrics of 3,475 participants in the Asymptomatic Polyvascular Abnormalities Community study (APAC) conducted in China (1,962 men and 1,513 women between the ages of 45 and 75 years) were collected. Based on the occurrence of newly found AICAS, all participants were divided into the AICAS group and non-ICAS group. Prevalence of ideal CVH metrics was compared between the two groups. Logistic regression was used to estimate the association of newly found AICAS with ideal CVH metrics. The result was the number of ideal CVH metrics was strongly associated with age, gender, education levels and family income (each P < 0.0001). Among the seven CVH metrics total cholesterol (TC) was the only one showing significant difference between the newly found AICAS group and non-ICAS group in our 2 years observation. Participants with less ideal CVH metrics (≤3) were associated with significantly higher prevalence of AICAS than those with more (>3) ideal CVH metrics (OR, 1.27; P = 0.045). Furthermore, less (≤3) ideal CVH metrics was markedly associated with higher incidence of AICAS for all participants, younger participants (<60 years) (OR, 1.34; P = 0.046) and men participants (OR, 1.53; P = 0.032) after adjustment for gender, age, education level, family income and stroke history. Thus we conclude that participants with newly found AICAS have high prevalence of total cholesterol status, and Individuals with low ideal CVH metrics (≤3) are associated with significantly higher prevalence of asymptomatic ICAS, especially in high-risk population of young and men participants. Therefore, primordial prevention of stroke should also focus on those high-risk populations.
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Bertuetti R, Gritti P, Pelosi P, Robba C. How to use cerebral ultrasound in the ICU. Minerva Anestesiol 2020; 86:327-340. [DOI: 10.23736/s0375-9393.19.13852-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Han D, Li H, Pan S, Xie S, Deryck Y, Luo Y, Li J, Ou-Yang C. Measuring Cerebral Carbon Dioxide Reactivity With Transcranial Doppler and Near-Infrared Spectroscopy in Children With Ventricular Septal Defect. J Cardiothorac Vasc Anesth 2020; 34:344-348. [DOI: 10.1053/j.jvca.2019.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 11/11/2022]
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Hsu KC, Lin CH, Johnson KR, Liu CH, Chang TY, Huang KL, Fann YC, Lee TH. Autodetect extracranial and intracranial artery stenosis by machine learning using ultrasound. Comput Biol Med 2020; 116:103569. [PMID: 31999553 DOI: 10.1016/j.compbiomed.2019.103569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND and Purpose: This study proposed a machine learning method for identifying ≥50% stenosis of the extracranial and intracranial arteries. PATIENTS AND METHODS A total of 8211 patients with both carotid ultrasound and cerebral angiography were enrolled. Support vector machine (SVM) was employed as the machine learning classifier. Carotid Doppler parameters and transcranial Doppler parameters were used as the input features. Feature selection was performed using the Extra-Trees (extremely randomized trees) method. RESULTS For the machine learning method, the sensitivities and specificities of identifying stenosis of the extracranial arteries were 88.5%-100% and 96.0%-100%, respectively. The sensitivities and specificities of identifying stenosis of the intracranial arteries were 71.7%-100% and 88.9%-100%, respectively. CONCLUSIONS The SVM classifier with feature selection is an efficient method for identifying the stenosis of both intracranial and extracranial arteries. Comparing with traditional Doppler criteria, this machine learning method achieves up to 20% higher in accuracy and 45% in sensitivity, respectively.
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Affiliation(s)
- Kai-Cheng Hsu
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States; Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Heng Lin
- Center for Information Technology, National Institutes of Health, Bethesda, MD, United States
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Chi-Hung Liu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yang-Cheng Fann
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States.
| | - Tsong-Hai Lee
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Spena G, Guerrini F, Grimod G, Salmaggi A, Mazzeo LA. Polymethyl Methacrylate Cranioplasty Is an Effective Ultrasound Window to Explore Intracranial Structures: Preliminary Experience and Future Perspectives. World Neurosurg 2019; 127:e1013-e1019. [PMID: 30974273 DOI: 10.1016/j.wneu.2019.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacrylate cranioplasties (PMMA-CP) and explore whether this material is a valid sonic window to explore intracerebral structures. METHODS In 6 patients, we performed transcranial sonography (TCS), using the PMMA-CP as sonic window. To test the reliability of ultrasound images, we collected several quantitative and qualitative measurements of intracranial structures and compared these sonographic images with standard computed tomography (CT) scan images. RESULTS We found that PMMA-CP is a very good sonic window and allowed us to obtain very good quality echographic images of intracranial structures, as shown by the comparison of measurements with CT scan, which were very reliable. The main drawback was related to the shape (i.e., the curvature) of the cranial flap, which hindered the ultrasound probe from correctly adhering to the scalp. CONCLUSIONS Although limited by the restricted number of cases, this preliminary experience represents the first available data about the serial use of TCS using PMMA-CP as window. These results open the path to the routine use of TCS to longitudinally control patients already harboring PMMA-CP. More, we here discuss its potential role in globally reducing the number of follow-up CT and magnetic resonance imaging scans required in different type of patients and pathologies.
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Affiliation(s)
- Giannantonio Spena
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Francesco Guerrini
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy; Unit of Neurosurgery, Department of Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Gianluca Grimod
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Andrea Salmaggi
- Unit of Neurology, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Lucio Aniello Mazzeo
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
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Conradi N, Hermsen A, Krause K, Gorny I, Strzelczyk A, Knake S, Rosenow F. Hemispheric language lateralization in presurgical patients with temporal lobe epilepsy: Improving the retest reliability of functional transcranial Doppler sonography. Epilepsy Behav 2019; 91:48-52. [PMID: 30217756 DOI: 10.1016/j.yebeh.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 11/16/2022]
Abstract
Since its introduction, functional transcranial Doppler sonography (fTCD) has been extensively applied in research and clinical settings and has now become part of the routine presurgical work-up of patients with epilepsy. Because of its importance in planning neurosurgical interventions and predicting possible cognitive risks, the reproducibility of fTCD in determining hemispheric language lateralization (HLL) has to be ensured. In the present study, fTCD was performed twice in 33 initially lateralized patients with temporal lobe epilepsy (TLE) as part of their presurgical work-up, using a standard word generation paradigm. Initially, the standard analysis, including only the statistical examination of fTCD data, was applied, and a rather poor retest reliability of r = 0.41 was obtained (p = 0.017). Because of doubts concerning appropriate task performance in some patients, subsequently, a two-step data analysis was introduced, including an additional qualitative evaluation of fTCD data regarding (1) instruction-compliant task performance, (2) sufficient quality of the baseline phase, and (3) adequate increase in cerebral blood flow velocity (CBFV) during the activation phase. Attributable to a more valid interpretation of fTCD data after the application of the qualitative step, the reproducibility of HLL significantly improved (p = 0.007) to a high retest reliability of r = 0.84 (p < 0.000). In clinical settings, psychological and situational factors seem to strongly influence the reproducibility of fTCD determining HLL. Accordingly, we highly recommend the complementation of the standard statistical examination of fTCD data by an additional qualitative evaluation (two-step data analysis), as this extra security is particularly desirable because of its direct implications for the further evaluation of neurosurgical interventions. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond".
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Affiliation(s)
- Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.
| | - Anke Hermsen
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Kristina Krause
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Iris Gorny
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
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Benson RA, Matthews D, Loftus V, Nicholson G, Tropman D, Loftus IM. Cerebral embolization during endovascular infrarenal, juxtarenal, and suprarenal aortic aneurysm repair, high-risk maneuvers, and associated neurologic outcomes. J Vasc Surg 2018; 68:1374-1381. [DOI: 10.1016/j.jvs.2018.01.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 01/16/2018] [Indexed: 12/01/2022]
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Beishon LC, Panerai RB, Robinson TG, Subramaniam H, Haunton VJ. The Assessment of Cerebrovascular Response to a Language Task from the Addenbrooke's Cognitive Examination in Cognitive Impairment: A Feasibility Functional Transcranial Doppler Ultrasonography Study. J Alzheimers Dis Rep 2018; 2:153-164. [PMID: 30480258 PMCID: PMC6218154 DOI: 10.3233/adr-180068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The incidence of dementia is predicted to rise rapidly, but sensitive diagnostic tests remain elusive. Changes in cerebral blood flow velocity (CBFv) can occur at an early stage of cognitive decline, and can be measured by transcranial Doppler ultrasonography (TCD). Objective: The aim of this study was to characterize the CBFv changes that occur in healthy older adults (HC), mild cognitive impairment (MCI), and Alzheimer’s disease (AD), in response to a language task from the Addenbrooke’s cognitive examination (ACE-III). Methods: Participants underwent bilateral TCD, continuous heart rate (ECG), end-tidal CO2 (capnography, ETCO2), and beat-to-beat blood pressure (Finometer, MAP), monitoring, during a 5-minute baseline, followed by cognitive tasks from the ACE-III. Data are presented for a language task (repeating words and phrases aloud), as peak percentage change in CBFv, HR, MAP, and ETCO2 from a normalized baseline. Results: 30 participants (mean age 73.2 years, 20% female) were recruited; HC (n = 10), MCI (n = 10), AD (n = 10). Language scores did not differ between groups (p = 0.16). Peak percentage change in CBFv differed between groups with the language task (HC: 15.9 (7.5)%, MCI: 6.7 (4.5)%, AD: 0.1 (7.1)%; p < 0.005). However, changes in MAP (HC: 7.9 (4.6)%, MCI: –0.1 (0.9)%, AD: 0.9 (4.4)%; p < 0.005), HR (HC: 8.8 (8.2)%, MCI: 0.7 (4.3)%, AD: –0.5 (5.6)%; p = 0.005), and ETCO2 (HC: –0.9 (3.2)%, MCI: 0.9 (3.2)%, AD: –5.2 (5.7)%; p = 0.006), also occurred. Conclusions: TCD measured CBFv changes to a language task from the ACE-III was feasible in a cognitively impaired population, further work is required in a larger population.
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Affiliation(s)
- Lucy C Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Hari Subramaniam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Leicestershire Partnership Trust, Evington Centre, Gwendolen Road, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Kaczynski J, Home R, Shields K, Walters M, Whiteley W, Wardlaw J, Newby DE. Reproducibility of Transcranial Doppler ultrasound in the middle cerebral artery. Cardiovasc Ultrasound 2018; 16:15. [PMID: 30200977 PMCID: PMC6131943 DOI: 10.1186/s12947-018-0133-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcranial Doppler ultrasound remains the only imaging modality that is capable of real-time measurements of blood flow velocity and microembolic signals in the cerebral circulation. We here assessed the repeatability and reproducibility of transcranial Doppler ultrasound in healthy volunteers and patients with symptomatic carotid artery stenosis. METHODS Between March and August 2017, we recruited 20 healthy volunteers and 20 patients with symptomatic carotid artery stenosis. In a quiet temperature-controlled room, two 1-h transcranial Doppler measurements of blood flow velocities and microembolic signals were performed sequentially on the same day (within-day repeatability) and a third 7-14 days later (between-day reproducibility). Levels of agreement were assessed by interclass correlation co-efficient. RESULTS In healthy volunteers (31±9 years, 11 male), within-day repeatability of Doppler measurements were 0.880 (95% CI 0.726-0.950) for peak velocity, 0.867 (95% CI 0.700-0.945) for mean velocity, and 0.887 (95% CI 0.741-0.953) for end-diastolic velocity. Between-day reproducibility was similar but lower: 0.777 (95% CI 0.526-0.905), 0.795 (95% CI 0.558-0.913), and 0.674 (95% CI 0.349-0.856) respectively. In patients (72±11 years, 11 male), within-day repeatability of Doppler measurements were higher: 0.926 (95% CI 0.826-0.970) for peak velocity, 0.922 (95% CI 0.817-0.968) for mean velocity, and 0.868 (95% CI 0.701-0.945) for end-diastolic velocity. Similarly, between-day reproducibility revealed lower values: 0.800 (95% CI 0.567-0.915), 0.786 (95% CI 0.542-0.909), and 0.778 (95% CI 0.527-0.905) respectively. In both cohorts, the intra-observer Bland Altman analysis demonstrated acceptable mean measurement differences and limits of agreement between series of middle cerebral artery velocity measurements with very few outliers. In patients, the carotid stenoses were 30-40% (n = 9), 40-50% (n = 6), 50-70% (n = 3) and > 70% (n = 2). No spontaneous embolisation was detected in either of the groups. CONCLUSIONS Transcranial Doppler generates reproducible data regarding the middle cerebral artery velocities. However, larger studies are needed to validate its clinical applicability. TRIAL REGISTRATION ClinicalTrial.gov (ID NCT 03050567), retrospectively registered on 15/05/2017.
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Affiliation(s)
- Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Rachel Home
- College of Medicine and Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Karen Shields
- Stroke Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Matthew Walters
- College of Medical, Veterinary and Life Sciences, Wolfson Medical School Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - William Whiteley
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Joanna Wardlaw
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
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Schaafsma A. A new method for correcting middle cerebral artery flow velocity for age by calculating Z-scores. J Neurosci Methods 2018; 307:1-7. [DOI: 10.1016/j.jneumeth.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/14/2022]
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Mursch K, Behnke-Mursch J. Polyether Ether Ketone Cranioplasties Are Permeable to Diagnostic Ultrasound. World Neurosurg 2018; 117:142-143. [PMID: 29920388 DOI: 10.1016/j.wneu.2018.06.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/10/2018] [Indexed: 11/30/2022]
Abstract
It is a common assumption that the human skull and solid skull implants are impermeable to diagnostic ultrasound. We demonstrated in 2 patients that frontoparietal polyetheretherketone cranioplasties allowed useful imaging of intracranial parenchymal and vascular structures with higher ultrasound frequencies than the 2 MHz used for the temporal bone window. This knowledge about additional imaging properties may be helpful in emergency situations and for vascular monitoring. The decision for a polyether ether ketone cranioplasty may contribute to patient safety.
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Affiliation(s)
- Kay Mursch
- Department of Neurosurgery, Zentralklinik, Bad Berka, Germany.
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Cerebral Ventricular Dimensions After Decompressive Craniectomy: A Comparison Between Bedside Sonographic Duplex Technique and Cranial Computed Tomography. Neurocrit Care 2018; 26:321-329. [PMID: 28054287 DOI: 10.1007/s12028-016-0359-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of this study was to assess and compare ventricle diameters in patients after decompressive craniectomy by using cranial computed tomography (CCT) versus sonographic duplex technique (SDT). METHODS A total of 102 consecutive patients after decompressive craniectomy following brain infarct, bleeding and trauma were examined by CCT and SDT. SDT was performed within 24 h after repeated postinterventional control CCT and the correlation between both methods was assessed via measurement of dimensions of all four ventricles. In addition, midline shifts and overall cerebral anatomy was evaluated. RESULTS A high correlation was found between CCT and SDT in measuring the diameters of all four ventricles (right lateral r = 0.978, p < 0.001; left lateral r = 0.975, p < 0.001; third r = 0.987, p < 0.001 and fourth ventricle r = 0.954, p < 0.001). Deviations of midline structure was observed in SDT as well as in CCT (r = 0.992, p < 0.001). CONCLUSION SDT in patients after decompressive craniectomy may represent an additional bedside tool to assess the dimensions of the ventricular system, anatomical structures, e.g., subdural hygromas, hematomas, midline shifts, gyri and sulci. The measurement of the dimensions of all four ventricles by using SDT delivers accurate values and may be considered as an alternative to CCT or a trigger for CCT prior to further treatment.
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Beishon LC, Williams CAL, Panerai RB, Robinson TG, Haunton VJ. The assessment of neurovascular coupling with the Addenbrooke’s Cognitive Examination: a functional transcranial Doppler ultrasonographic study. J Neurophysiol 2018; 119:1084-1094. [DOI: 10.1152/jn.00698.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cerebrovascular dysfunction occurs early in dementia and can be identified by transcranial Doppler ultrasonography (TCD). Few studies have examined cerebral blood flow velocity (CBFv) responses to a detailed cognitive battery. This study aimed to characterize all CBFv responses, and the effect of hemispheric dominance, to the Addenbrooke’s Cognitive Examination (ACE-III) in healthy volunteers. Forty volunteers underwent continuous bilateral TCD, beat-to-beat blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (ETCO2; capnography) monitoring. After a 5-min baseline period, all tasks from the ACE-III were performed in 3 sections (A: attention, fluency, memory; B: language; C: visuospatial, memory). Data are population mean normalized percentage (PM%) change from a 20-s baseline period before task initiation. Forty bilateral data sets were obtained (27 women, 37 right-hand dominant). All paradigms produced a sharp increase in CBFv in both dominant (PM% range: 3.29 to 9.70%) and nondominant (PM% range: 4.34 to 11.63%) hemispheres at task initiation, with associated increases in MAP (PM% range: 3.06 to 16.04%). ETCO2 did not differ significantly at task initiation (PM% range: −1.1 to 2.4%, P > 0.05). HR differed significantly across A and C tasks at initiation (PM% range: −1.1 to 2.4%, P < 0.05), but not B tasks. In conclusion, all tasks resulted in increases in CBFv, differing significantly between paradigms. These results require further investigation in a cognitively impaired population. NEW & NOTEWORTHY This study is the first to provide a normative data set of cerebral blood flow velocity (CBFv) responses to a complete cognitive assessment (Addenbrooke’s Cognitive Examination, ACE-III) in a large sample ( n = 40) of healthy volunteers. All tasks produced peak and sustained increases in CBFv to different extents. The ACE-III is a feasible tool to assess neurovascular coupling with transcranial Doppler ultrasonography. These data can be used to inform the most appropriate cognitive task to elicit CBFv responses for future studies.
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Affiliation(s)
- Lucy C. Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Claire A. L. Williams
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
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Ertl M, Raasch N, Hammel G, Harter K, Lang C. Transtemporal Investigation of Brain Parenchyma Elasticity Using 2-D Shear Wave Elastography: Definition of Age-Matched Normal Values. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:78-84. [PMID: 28982629 DOI: 10.1016/j.ultrasmedbio.2017.08.1885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
The goal of our research was to assess the possibility of reliable investigation of brain tissue stiffness using ultrasonographic brain parenchyma elastography with an intact temporal bone. We enrolled 108 patients after exclusion of intracranial pathology or healthy volunteers. All patients were subdivided by age into groups: 20-40, 40-60 and >60 y. For statistical analysis, the χ2 test and t-test were used. The mean values, regardless of age and other parameters, were 3.34 kPa (SD = 0.59) on the left side and 3.33 kPa (SD = 0.58) on the right side. We found no correlation between the values, body mass index (r = 0.07, p = 0.48) and sex (t = -0.11, p = 0.91), but we observed a highly significant correlation between the values and age (r = 0.43, p <0.0001). We found ultrasonographic brain parenchyma elastography to be a valid, reproducible and investigator-independent method that reliably determines brain parenchyma stiffness. Normal values should serve as a reference for studies on various intracranial lesions.
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Affiliation(s)
- Michael Ertl
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany.
| | - Nele Raasch
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
| | - Gertrud Hammel
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Center for Environmental Health, Augsburg, Germany; CK-CARE, Christine Kühne - Center for Allergy and Research and Education, Davos, Switzerland
| | - Katharina Harter
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Center for Environmental Health, Augsburg, Germany; CK-CARE, Christine Kühne - Center for Allergy and Research and Education, Davos, Switzerland
| | - Christopher Lang
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
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Clinical Importance of Temporal Bone Features for the Efficacy of Contrast-Enhanced Sonothrombolysis: a Retrospective Analysis of the NOR-SASS Trial. Transl Stroke Res 2017; 9:333-339. [PMID: 29119369 DOI: 10.1007/s12975-017-0583-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
Contrast-enhanced sonothrombolysis (CEST) seems to be a safe and promising treatment in acute ischemic stroke. It remains unknown if temporal bone features may influence the efficacy of CEST. We investigated the association between different temporal bone features on admission computed tomography (CT) scan and the outcome in acute ischemic stroke patients included in the randomized Norwegian Sonothrombolysis in Acute Stroke Study (NOR-SASS). Patients diagnosed as stroke mimics and those with infratentorial stroke or with incorrect insonation were excluded. We retrospectively assessed temporal bone heterogeneity (presence of diploë), diploë ratio, thickness, and density on admission CT scans. National institute of Health Stroke Scale (NIHSS) at 24 h and modified Rankin Scale (mRS) at 3 months were correlated with CT findings both in CEST and sham CEST patients. A total of 99 patients were included of which 52 were assigned to CEST and 47 to sham CEST. Approximately 20% patients had a heterogeneous temporal bone in both the CEST and sham CEST group. All temporal bone CT features studied were associated with female sex. In the CEST group, temporal bone heterogeneity (p = 0.006) and higher temporal bone diploë ratio (p = 0.002) were associated with higher NIHSS at 24 h. There was no association between temporal bone features and mRS at 3 months. Approximately 20% of acute ischemic stroke patients have heterogeneous temporal bone and may be resistant to standard 2-MHz transcranial Doppler ultrasound treatment. Sonothrombolysis resistance may easily be predicted by admission CT for better selection.
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Miller S, Mitra K. NIRS-based cerebrovascular regulation assessment: exercise and cerebrovascular reactivity. NEUROPHOTONICS 2017; 4:041503. [PMID: 28924565 PMCID: PMC5595228 DOI: 10.1117/1.nph.4.4.041503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/15/2017] [Indexed: 05/20/2023]
Abstract
Alterations to cerebral blood flow (CBF) have been implicated in diverse neurological conditions. Near-infrared spectroscopy (NIRS)-measured regional cerebral tissue oxygen saturation ([Formula: see text]) provides an estimate of oxygenation of interrogated cerebral volume useful in identifying variations in oxygen supply to cerebral tissue and in monitoring cerebrovascular function. [Formula: see text]-inhalation-based hypercapnic breathing challenges were used to simulate CBF dysregulation, utilizing NIRS to monitor the CBF autoregulatory response. A breathing circuit was designed to administer [Formula: see text]-compressed air mixtures and assess CBF regulatory responses to hypercapnia in 26 healthy young adults. One to three hypercapnic challenges of 5 or 10 min duration were delivered to each subject while continuously monitoring [Formula: see text], partial pressure of end tidal [Formula: see text] ([Formula: see text]), and vital signs. Change in [Formula: see text] ([Formula: see text]) during [Formula: see text] inhalation positively correlated to [Formula: see text] ([Formula: see text]). Grouping subjects into three exercise factor levels (h/week), (1) 0, (2) [Formula: see text] and [Formula: see text], and (3) [Formula: see text] showed significantly greater [Formula: see text] responses to [Formula: see text] challenges for level 3 subjects but similar [Formula: see text] responses for the three groups. Exercising greater than 10 h/week may produce a higher resting cerebrovascular reactivity (CVR) to [Formula: see text] inhalation. Establishing baseline values of [Formula: see text] and CVR to [Formula: see text] may aid in early detection of CBF changes.
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Affiliation(s)
- Stephanie Miller
- Florida Institute of Technology, Department of Mechanical and Aerospace Engineering, Melbourne, Florida, United States
- Address all correspondence to: Stephanie Miller, E-mail:
| | - Kunal Mitra
- Florida Institute of Technology, Department of Biomedical Engineering, Melbourne, Florida, United States
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Chi NF, Ku HL, Wang CY, Liu Y, Chan L, Lin YC, Peng CK, Novak V, Hu HH, Hu CJ. Dynamic Cerebral Autoregulation Assessment Using Extracranial Internal Carotid Artery Doppler Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1307-1313. [PMID: 28411965 DOI: 10.1016/j.ultrasmedbio.2017.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/07/2017] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
Transcranial Doppler ultrasonography of the middle cerebral artery (MCA) is frequently used to assess dynamic cerebral autoregulation (dCA); however, this is difficult in patients with poor temporal bone windows. In the study described here, we investigated the agreement and sensitivity of dCA indices determined from the extracranial internal carotid artery (ICA) and those determined from the MCA. Measurements for 32 stroke patients and 59 controls were analyzed. Measurement of the mean flow correlation index (Mx) and transfer function analysis based on spontaneous blood pressure fluctuation were simultaneously performed for the extracranial ICA and MCA. The mean values of Mx and phase shift did not significantly differ between the ICA and MCA (mean difference: Mx = 0.01; phase shift of very low frequency [VLF] = 0.7°, low frequency [LF] = 3.3° and high frequency = 4.5°), but the gains in VLF and LF in the ICA were significantly lower than those in the MCA (mean difference: gain of VLF = -0.13, gain of LF = -0.10). The intra-class correlation coefficient between the dCA indices of the ICA and MCA was favorable in Mx (0.76) and the phase shift of VLF (0.72). The area under the receiver operating characteristic curve for stroke diagnosis did not differ among the dCA indices. We conclude that dCA assessed from the ICA is as effective as that from the MCA, but the results are not interchangeable.
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Affiliation(s)
- Nai-Fang Chi
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Hsiao-Lun Ku
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yen Wang
- Research Center for Adaptive Data Analysis, National Central University, Taoyuan, Taiwan
| | - Yanhui Liu
- Fengsheng Yongkang Software Technology Corporation, Nanjing, China
| | - Lung Chan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chin Lin
- Health Management Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vera Novak
- Departments of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Han-Hwa Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Huang S, Shekhar H, Holland CK. Comparative lytic efficacy of rt-PA and ultrasound in porcine versus human clots. PLoS One 2017; 12:e0177786. [PMID: 28545055 PMCID: PMC5435301 DOI: 10.1371/journal.pone.0177786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/03/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction Porcine thrombi are employed routinely in preclinical models of ischemic stroke. In this study, we examined the differential lytic susceptibility of porcine and human whole blood clots with and without the use of microbubbles and ultrasound (US) as an adjuvant. Materials and methods An in vitro system equipped with time-lapse microscopy was used to evaluate recombinant tissue-plasminogen activator (rt-PA) lysis of porcine and human clots in the same species or cross species plasma. Human and porcine whole blood clots were treated with rt-PA and an echo contrast agent, Definity®, and exposed to intermittent 120 kHz US. Results and conclusions The rt-PA lytic efficacy observed for porcine clots in porcine plasma was 22 times lower than for human clots in human plasma reported previously. Further, porcine clots did not exhibit increased lysis with adjuvant Definity® and US exposure. However, the rt-PA lytic susceptibility of the porcine clots in human plasma was similar to that of human clots in human plasma. Human clots perfused with porcine plasma did not respond to rt-PA, but adjuvant use of Definity® and US enhanced lysis. These results reveal considerable differences in lytic susceptibility of porcine clots and human clots to rt-PA. The use of porcine clot models to test new human thrombolytic therapies may necessitate modulation of coagulation and thrombolytic factors to reflect human hemostasis accurately.
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Affiliation(s)
- Shenwen Huang
- Department of Biomedical, Chemical, & Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Himanshu Shekhar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Christy K. Holland
- Department of Biomedical, Chemical, & Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
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