Anthony Anzalone, MS
Medical Student
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Stacey Wolfe, MD
Associate Professor, Neurosurgery
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Aarti Sarwal, MD, FAAN, FNCS,FCCM
Medical Director, Neurocritical Care
Wake Forest Baptist Health Center
Winston-Salem, North Carolina
Disclosure information not submitted.
Title: Scoping Review of Literature on B-Mode Cranial Ultrasonography to Detect Intracranial Hemorrhage
Introduction: Transcranial color-coded sonography is a commonly used diagnostic modality for evaluating cerebrovascular pathology. Acquisition of B mode image is the initial step towards image acquisition, but parenchymal assessment using B mode has not been used widely. With emerging reports on point of care cranial ultrasound imaging of intracranial hemorrhage (ICH) in addition to other applications in critical care, we undertook a scoping review of literature to evaluate the utility of cranial ultrasound B mode in ICH diagnosis.
Methods: We conducted a literature search on PubMed, Embase, Cochrane, Web of Science, Scopus, and CINAHL databases to identify articles evaluating the use of ultrasound (US) in ICH diagnosis compared to computed tomography (CT) or magnetic resonance imaging (MRI) using a wide net MeSH terms. All pediatric and adult studies were included if they reported at least one measure of diagnostic accuracy. Exclusion criteria included neonatal studies, studies reporting only doppler findings, post-mortem studies, animal studies, and studies that lacked corroborating CT or MRI. Measures of diagnostic accuracy were extracted.
Results: We identified a total of 15 studies meeting criteria (14 adult, 1 pediatric) conducted between January 1990 and July 2021. The diagnostic accuracy of cranial US in identifying ICH compared to CT or MRI was reported at 95% in two studies. Six studies reported sensitivities ranging from 46.7% to 100%. Four studies reported specificities with ranges from 92.9% to 100%. Small vessel disease and micro-hemorrhages were the most often reported false positive findings. The correlation coefficient (R) between cranial US-derived and CT-derived ICH volume ranged from 0.4 to 0.981. None of these studies used point of care US machines.
Conclusions: Cranial ultrasound may have clinical applications in point of care ICH diagnosis, especially in austere environments or where CT head is not accessible to a critically ill patient. Appropriate ultrasound presets using latest advances in ultrasound technology may improve diagnostic accuracy of this modality and need further investigation.