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TCCD Fusion Imaging to Estimate Intracranial Pressure and Tissue Displacement with Large Hemispheric Infarction

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Abstract

Background

Despite breakthroughs in stroke treatment, some patients still experience large infarctions of the cerebral hemispheres resulting in mass effect and tissue displacement. The evolution of mass effect is currently monitored using serial computed tomography (CT) imaging. However, there are patients who are ineligible for transport, and there are limited options for bedside monitoring of unilateral tissue shift.

Methods

We used fusion imaging for overlaying transcranial color duplex with CT angiography. This method allows overlay of live ultrasound on top of CT or magnetic resonance imaging scans. Patients with large hemispheric infarctions were eligible to participate. Position data from the source files were used and matched with live imaging and correlation to magnetic probes on the patient’s forehead and ultrasound probe. Shift of cerebral parenchyma, displacement of the anterior cerebral arteries, basilary artery and third ventricle were analyzed, as well as pressure on the midbrain, and the displacement of the basilar artery on the head were analyzed. Patients received multiple examinations in addition to standard care of treatment with CT imaging.

Results

The sensitivity for diagnosing a shift of 3 mm with fusion imaging was 100%, with a specificity of 95%. No side effects or interactions with critical care equipment were recorded.

Conclusions

Fusion imaging is an easy method to access and acquire measurements for critical care patients and follow-up of tissue and vascular displacement after stroke. Fusion imaging may be a decisive support for indicating hemicraniectomy.

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Funding

No funding involved in this study.

Author information

Authors and Affiliations

  1. Department of Neurology and Neurocritical Care Medicine, Shaare Zedek Medical Center, Jerusalem, Israel

    Stefan Mausbach

  2. Department of Neurology, Justus-Liebig University Hospital Giessen, Giessen, Germany

    Teresa van Spankeren, Ingo Schirotzik, Maxime Viard & Manfred Kaps

  3. Institute for Medical Informatics, Justus-Liebig University Hospital Giessen, Giessen, Germany

    Helge Hudel

  4. Department for Neuroradiology, Justus-Liebig University Hospital Giessen, Giessen, Germany

    Tobias Struffert

  5. Shmuel Bait Street, 9103102, Jerusalem, Israel

    Stefan Mausbach

Authors
  1. Stefan Mausbach
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  2. Teresa van Spankeren
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  3. Helge Hudel
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  4. Ingo Schirotzik
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  5. Maxime Viard
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  6. Tobias Struffert
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  7. Manfred Kaps
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Contributions

SM: Main Author, Study Designer, performed parts of the examination. TS: Main Author and part of her Ph.D. work, performed most of the examinations. HH: Data ETL, helped with statistics and elaborating the correction formular, deceased. IS and MV: responsible for the intensive care unit and patient acquisition. TS: Responsible for computed tomography and computed tomography angiography imaging and converting source files data for the study. MK: Review and editing of the paper, allowing the study in his department. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Stefan Mausbach.

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Mausbach, S., van Spankeren, T., Hudel, H. et al. TCCD Fusion Imaging to Estimate Intracranial Pressure and Tissue Displacement with Large Hemispheric Infarction. Neurocrit Care 40, 562–567 (2024). https://doi.org/10.1007/s12028-023-01784-4

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  • DOI: https://doi.org/10.1007/s12028-023-01784-4

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