title: Comparison between Brain Computed Tomography Scan and Transcranial Sonography to Evaluate Third Ventricle Width, Peri-Mesencephalic Cistern, and Sylvian Fissure in Traumatic Brain-Injured Patients.
abstract: BACKGROUND
  Transcranial color-coded duplex sonography (TCCS) may help guide multimodal monitoring in the neurocritical setting. It may provide indirect information about intracranial hypertension, such as midline shift, third ventricle width, and peri-mesencephalic cistern obliteration. We aim to assess the agreement between brain computed tomography scan (CT scan) and TCCS in traumatic brain injury (TBI) patients.
  
  
  METHODS
  In this retrospective cross-sectional observational study, TCCS was performed within 6 h before a brain CT scan. Only the first CT and TCCS after ICU admission were included. The agreement between the CT scan and TCCS was assessed by Bland-Altman plots and evaluating the intraclass correlation coefficient.
  
  
  RESULTS
  Overall, 15 consecutive patients were included (80% male, 42 ± 23 years of age, Glasgow Coma Score 5 [4,6]). The mean difference between the brain CT scan and TCCS in measuring the midline shift was 0.30 ± 2.1 mm (intraclass correlation coefficient: 0.93;p< 0.01). An excellent correlation was also observed between the methods in assessing the third ventricle width (intraclass correlation coefficient: 0.88;p< 0.01). Bland-Altman plots did not show any systematic bias in either agreement analysis. TCCS showed good accuracy in predicting non-compressed peri-mesencephalic cisterns (AUC: 0.83, 95% CI 0.46-1.0) and the presence of the Sylvian fissure (AUC: 0.91, 95% CI 0.73-1.0) on CT scan.
  
  
  CONCLUSIONS
  TCCS is a promising tool and may be an alternative to CT scans for evaluating TBI patients.
authors.affiliation: Intensive Care Unit, Discipline of General Surgery and Trauma, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Raphael A G
authors.initials: RA
authors.lastname: Oliveira
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: de Oliveira Lima
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
authors.affiliation: Intensive Care Unit, Discipline of General Surgery and Trauma, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Luiz Marcelo
authors.initials: LM
authors.lastname: de Sá Malbouisson
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Manuel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, São Paulo University Medical School , São Paulo , Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
keywords: midline shift; perimesencephalic cisterns; sylvian fissure; transcranial color-coded sonography; traumatic brain injury