Morphological and Hemodynamic Evaluations by Means of Transcranial Power Doppler Imaging in Patients with Severe Head In
The following conditions of 17 patients with severe head injury (ages 9’76; mean 37:12 focal and 5 diffuse injuries) were evaluated during acute phase (1–14 days after injury, mean 5) by transcranial power Doppler imaging (PDI), a new color Doppler ultras
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Morphological and Hemodynamic Evaluations by Means of Transcranial Power Doppler Imaging in Patients with Severe Head Injury T. Shiogai, K. Nagayama, G. Damrinjap, K. Saruta, M. Hara, and I. Saito Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
Summary The following conditions of 17 patients with severe head injury (ages 9-76; mean 37: 12 focal and 5 diffuse injuries) were evaluated during acute phase (1-14 days after injury, mean 5) by transcranial power Doppler imaging (PD1), a new color Doppler ultrasound technique: a) morphological changes via temporal window, b) hemodynamic changes in major intracraniaUcervical arteries based on measured angle-corrected time-averaged mean (TAM)! peak velocities and vessel diameter (Va), and calculated pulsatility indices (PI), vessel area (Va), and flow volume (Vf = TAM x Va). a) 1) Major trunks of intracranial vessels and circle of Willis and pathological changes in frontal!temporallobes and midbrain were finely visualized. 2) Contusional hemorrhage and cerebral contusion demonstrated irregular hyper- and hypo-echoic lesions, respectively. 3) Delayed epidural hematoma showed a hyper-echoic band. b) 1) Decreased velocities, significant PI increase, and Va increase tendency were observed in intracranial arteries. 2) Increased velocities with Vf increase but no Va decrease indicated hyperemia rather than vasospasm. 3) Va in the intracranial vessels, however, tended to increase PDI appears useful in evaluating real-time and simultaneous morphological and hemodynamic information in pathogenesis and neurointensive care of patients with severe head injury. Keywords: Severe head injury; sonography; transcranial power Doppler.
and major vessels in the basal brain. In addition, evaluation of blood flow volume (Vf) through measurement of vessel diameter (Vd) and flow velocity of the extracranial vessels using CFI also has been made [15,16]. There have been no reports elsewhere of such study involving measurement of Vf in the intracranial arteries In this respect, our previous study utilizing CFI pointed out problems derived from reliability of Vd measurement and calculated vessel area (Va) due to poor visualization of vessel contour [18]. To overcome this, we have introduced power Doppler imaging (PDI) because it is supperior to CFI with respect to visualization of intracranial vessels [7,19]. The objective of this study was to clarify the significance of transcranial PDI in morphological and hemodynamic evaluations of patients with severe head injury on the basis of Vd measurement and Vf estimation.
Subjects and Method Introduction No method which can simultaneously evaluate hemodynamic and morphological changes and repeat non-invasively at bedside has been introduced for neurointensive care of patients with severe head injury Doppler color flow imaging (CFI) or colorcoded realtime sonography (2) or color-coded duplex sonography [17] has been used transcranially to visualize changes in intracranial brain parenchyma
The subjects were 17 comatose patient
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