Transcranial duplex ultrasound as an outcome predictor tool in spontaneous intracerebral hemorrhage

Abstract

Background and purpose: To assess the usefulness of transcranial color-coded duplex (TCCD) ultrasound for monitoring intracerebral hemorrhage (ICH) and to analyze its prognostic predictive performance. Materials and methods: Prospective observational study of consecutive patients with spontaneous supratentorial ICH admitted to a stroke unit between 2017-2020. Clinical characteristics, ICH volume and midline shift (MLS) measured by computed tomography (CT) and TCCD were recorded at first 24 hours and at 2 and 7 days. ICH volume and MLS were correlated with CT and TCCD. Adjusted logistic regression analyses was performed to determine the association with 3-month dependence/death. A receiver operating characteristic (ROC) analysis was used to identify the MLS cut-off point with the highest predictive value. Results: Sixty-five patients were included, 23 (35%) women, with a mean age of 67 (SD 15) years and an NIHSS on admission of 12 (SD 7). Strong positive correlations were observed between CT and TCCD at 24, 48 hours and 7 days for ICH volume (r=0.871, r=0.839, r=0.700) and moderate positive correlations for MLS (r=0.658, r=0.637, r=0.593). A higher TCCD-MLS at 48 hours was independently associated with greater mortality, and a higher TCCD-ICH volume at 48 hours with poorer functional outcomes. MLS ≥7 mm predicted mortality with a sensitivity of 80% and specificity of 99% (AUC 0.924). Conclusion: TCCD-ICH volume and MLS could be used as predictive markers for dependency and mortality at three months, respectively. TCCD is a useful tool for monitoring patients with supratentorial ICH; however, these findings should be confirmed with larger studie