title: Noninvasive detection of elevated intracranial pressure using a portable ultrasound system.
abstract: OBJECTIVE
  The aim of this study is to prospectively compare the accuracies of transcranial color-coded sonography (TCCS) and transcranial Doppler (TCD) in the diagnosis of elevated intracranial pressure.
  
  
  METHODS
  A prospective, blinded, head-to-head comparison of TCD and TCCS methods using intracranial pressure (ICP) measured continuously via an intraparenchymal catheter as the reference standard in 2 groups of 20 neurocritical care patients each: high ICP (group 1) and normal ICP (group 2). Middle cerebral artery (MCA) pulsatility index (PI) recordings from all patients' sonographic reports were selected based on the highest left or right recorded MCA PI. Transcranial Doppler was performed using a dedicated TCD device, and TCCS was performed using a portable ultrasound system.
  
  
  RESULTS
  The PI values obtained did not differ significantly between the 2 methods (group 1, P = .46; group 2, P = .11). Linear regression analysis identified a significant relationship between PI obtained with both methods (r = 0.897; P < .0001). The duration of PI measurement was statistically longer with TCCS than TCD (group 1, P < .01; group 2, P < .01). Diagnostic accuracies were good and similar for both methods (TCD area under curve, 0.901; TCCS area under curve 0.870; P = .69).
  
  
  CONCLUSIONS
  This work is a pilot study comparing TCCS and TCD in the detection of elevated ICP. This study suggests that a bedside portable ultrasound system may be useful to determine MCA PI with accuracy similar to that of a dedicated TCD device.
authors.affiliation: Department of Emergency, Anesthesiology and Critical Care, Sainte Anne Military Teaching Hospital, Toulon 83041, France. bertrand.prunet@orange.fr
authors.forename: Bertrand
authors.initials: B
authors.lastname: Prunet
authors.forename: Yves
authors.initials: Y
authors.lastname: Asencio
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lacroix
authors.forename: Ambroise
authors.initials: A
authors.lastname: Montcriol
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dagain
authors.forename: Jean
authors.initials: J
authors.lastname: Cotte
authors.forename: Pierre
authors.initials: P
authors.lastname: Esnault
authors.forename: Henry
authors.initials: H
authors.lastname: Boret
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
authors.forename: Eric
authors.initials: E
authors.lastname: Kaiser
mesh_terms: D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011446:Prospective Studies; D016037:Single-Blind Method; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation*