title: Image-guided transcranial Doppler sonography for monitoring of vasospasm after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Transcranial Doppler ultrasound (TCD) is a standard method for bedside vasospasm monitoring after subarachnoid hemorrhage (SAH). Image guidance has previously been shown to reduce intra- and interobserver variability of this method. The aim of the present study was to compare image-guided and conventional TCD in vasospasm monitoring after SAH.
  
  
  METHODS
  418 TCD exams of 24 consecutive SAH patients registered in a database were evaluated. Of these, 130 image-guided exams were identified which had been performed on the same day as conventional Doppler exams. These matched pairs were taken for statistical analysis. Data were tested statistically using the sign test applied at patient level to aggregated data.
  
  
  RESULTS
  The rate of complete exams (both M1, A1, P1 segments) was significantly higher in image-guided exams (92% vs. 74%, p<0.001), and the superiority of image-guided exams was significantly related to smaller sizes of the temporal bone window. There were more exams with Doppler sonographic vasospasm (mean flow velocity>120cm/s) in image-guided exams (38% vs. 33%) which, however, did not reach statistical significance.
  
  
  CONCLUSIONS
  Image-guidance leads to a standardization of serial TCD exams, which resulted in significantly more complete exams, most prominent in patients with poor temporal bone windows, and a higher detection rate of Doppler sonographic vasospasms. Image-guided TCD therefore has the capability to improve bedside vasospasm monitoring after SAH.
authors.affiliation: Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. Electronic address: axel.neulen@unimedizin-mainz.de.
authors.forename: A
authors.initials: A
authors.lastname: Neulen
authors.affiliation: Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Prokesch
authors.affiliation: Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes-Gutenberg-University of Mainz, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
authors.forename: J
authors.initials: J
authors.lastname: König
authors.affiliation: Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Giese
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Acoustic window; Bone window; ICU; Image guidance; Neurointensive care; Neuronavigation; Neurovascular diseases; Subarachnoid hemorrhage; TCD; Transcranial Doppler sonography; Ultrasound; Vasospasm; Vasospasm monitoring