title: Usefulness of transcranial echography in patients with decompressive craniectomy: a comparison with computed tomography scan.
abstract: OBJECTIVE
  To assess the agreement between computed tomography and transcranial sonography in patients after decompressive craniectomy.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  The medical intensive care unit of a university-affiliated teaching hospital.
  
  
  METHODS
  Thirty head-injured patients consecutively admitted to the intensive care unit of "A. Gemelli" Hospital who underwent decompressive craniectomy were studied. Immediately before brain cranial tomography, transcranial ultrasonography was performed.
  
  
  RESULTS
  The mean difference between computed tomography and echography in measuring the dislocation of midline structures was 0.3 ± 1.6 mm (95% confidence interval 0.2-0.9 mm; intraclass correlation coefficient, 0.979; p < .01). An excellent correlation was found between computed tomography and transcranial sonography in assessing volumes of hyperdense lesions (intraclass correlation coefficient, 0.993; p < .01). Lesions that appear hypodense on computed tomography scan were divided in ischemic and late hemorrhagic. No ischemic lesion was localized on echography; a poor correlation was found between computed tomography and echography in assessing the volume of late hemorrhagic lesions (intraclass correlation coefficient, 0.151; p = .53). A quite good correlation between transcranial ultrasonography and computed tomography was found in measuring lateral ventricles width (intraclass correlation coefficient, 0.967; p < .01). Sensitivity and specificity of transcranial ultrasonography in comparison with computed tomography to detect the position of intracranial pressure catheter was 100% and 78%.
  
  
  CONCLUSIONS
  Echography may be a valid option to computed tomography in patients with decompressive craniectomy to assess the size of acute hemorrhagic lesions, to measure midline structures and the width of lateral ventricles, and to visualize the tip of the ventricular catheter.
authors.affiliation: Institute of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy. anselmo.caricato@rm.unicatt.it
authors.forename: Anselmo
authors.initials: A
authors.lastname: Caricato
authors.forename: Vittorio
authors.initials: V
authors.lastname: Mignani
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bocci
authors.forename: Mariano Alberto
authors.initials: MA
authors.lastname: Pennisi
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandroni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tersali
authors.forename: Alessandra
authors.initials: A
authors.lastname: Antonaci
authors.forename: Chiara
authors.initials: C
authors.lastname: de Waure
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial