Usefulness of Transcranial Doppler-Derived Cerebral Hemodynamic Parameters in the Noninvasive Assessment of Intracranial Pressure

Benjamin R. Wakerley, Yohanna Kusuma, Leonard L.L. Yeo, Shen Liang, Komal Kumar, Arvind K. Sharma, Vijay K. Sharma

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)

Abstract

BACKGROUND: Transcranial Doppler (TCD) ultrasonography is a noninvasive bedside tool that can evaluate cerebral blood flow hemodynamics in major intracranial arteries. TCD-derived pulsatility index (PI) is believed to be influenced by intracranial pressure (ICP). OBJECTIVE: To correlate TCD-PI with cerebrospinal fluid (CSF) pressure (representing ICP), measured by standard lumbar puncture (LP) manometry. METHODS: CSF pressures (CSF-P) were measured in 78 patients by LP manometry. Stable TCD spectra were obtained 5 minutes before LP from either middle cerebral arteries using Spencer's head frame and 2-MHz transducer. PI values were calculated from the TCD spectra by an independent neurosonologist. RESULTS: Factors displaying a significant relationship with CSF-P included age (R = -.426, P < .0005); EDV (R = -.328, P = .002;) and PI (R = .650, P < .0005). On analyzing dichotomized data (CSF-P < 20 vs. ≥ 20 cm H20) TCD-PI was an independent determinant (OR per .1 increase in PI = 2.437; 95% CI, 1.573-3.777; P < .0005). PI ≥ 1.26 could reliably predict CSF-P ≥ 20 cm H20 (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 81.1%, 96.3%, 93.8%, 88.1%, and 90.1% respectively). CONCLUSION: TCD-derived PI could be used to identify patients with CSF-P ≥ 20 cm H20 and may play an important role as a monitoring tool.

Original languageEnglish
Pages (from-to)111-116
Number of pages6
JournalJournal of Neuroimaging
Volume25
Issue number1
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Intracranial pressure
  • Pulsatility index
  • Resistance index
  • Transcranial Doppler

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