Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
J Neuroimaging. 2023 May-Jun;33(3):333-358. doi: 10.1111/jon.13087. Epub 2023 Jan 29.
Transcranial ultrasonography (TCU) can be a useful diagnostic tool in evaluating intracranial pathology in patients with limited or delayed access to routine neuroimaging in critical care or austere settings. We reviewed available literature investigating the diagnostic utility of TCU for detecting pediatric and adult patient's intracranial pathology in patients with intact skulls and reported diagnostic accuracy measures.
We performed a systematic review of PubMed , Cochrane Library, Embase , Scopus , Web of Science™, and Cumulative Index to Nursing and Allied Health Literature databases to identify articles evaluating ultrasound-based detection of intracranial pathology in comparison to routine imaging using broad Medical Subject Heading sets. Two independent reviewers reviewed the retrieved articles for bias using the Quality Assessment of Diagnostic Accuracy Studies tools and extracted measures of diagnostic accuracy and ultrasound parameters. Data were pooled using meta-analysis implementing a random-effects approach to examine the sensitivity, specificity, and accuracy of ultrasound-based diagnosis.
A total of 44 studies out of the 3432 articles screened met the eligibility criteria, totaling 2426 patients (Mean age: 60.1 ± 14.52 years). We found tumors, intracranial hemorrhage (ICH), and neurodegenerative diseases in the eligible studies. Sensitivity, specificity, and accuracy of TCU and their 95% confidence intervals were 0.80 (0.72, 0.89), 0.71 (0.59, 0.82), and 0.76 (0.71, 0.82) for neurodegenerative diseases; 0.88 (0.74, 1.02), 0.81 (0.50, 1.12), and 0.94 (0.92, 0.96) for ICH; and 0.97 (0.92, 1.03), 0.99 (0.96, 1.01), and 0.99 (0.97, 1.01) for intracranial masses. No studies reported ultrasound presets.
TCU has a reasonable sensitivity and specificity for detecting intracranial pathology involving ICH and tumors with clinical applications in remote locations or where standard imaging is unavailable. Future studies should investigate ultrasound parameters to enhance diagnostic accuracy in diagnosing intracranial pathology.
经颅超声（TCU）在评估重症监护或恶劣环境下常规神经影像学检查受限或延迟的患者的颅内病变方面是一种有用的诊断工具。我们回顾了现有的研究文献，这些文献调查了 TCU 在检测颅骨完整的儿科和成年患者颅内病变方面的诊断效用，并报告了诊断准确性测量值。
我们对 PubMed、Cochrane 图书馆、Embase、Scopus、Web of Science™和 Cumulative Index to Nursing and Allied Health Literature 数据库进行了系统评价，以确定评估超声检测颅内病变与使用广泛的医学主题词集进行常规成像的比较的文章。两名独立的审查员使用诊断准确性研究质量评估工具评估了检索到的文章的偏倚，并提取了诊断准确性和超声参数的测量值。使用荟萃分析汇总数据，采用随机效应方法检查基于超声的诊断的敏感性、特异性和准确性。
在筛选出的 3432 篇文章中，共有 44 篇符合入选标准，共纳入 2426 名患者（平均年龄：60.1±14.52 岁）。我们在合格研究中发现了肿瘤、颅内出血（ICH）和神经退行性疾病。TCU 的敏感性、特异性和准确性及其 95%置信区间分别为神经退行性疾病 0.80（0.72，0.89）、0.71（0.59，0.82）和 0.76（0.71，0.82）；ICH 为 0.88（0.74，1.02）、0.81（0.50，1.12）和 0.94（0.92，0.96）；颅内肿块为 0.97（0.92，1.03）、0.99（0.96，1.01）和 0.99（0.97，1.01）。没有研究报告超声预设。
TCU 在检测涉及 ICH 和肿瘤的颅内病变方面具有合理的敏感性和特异性，在偏远地区或无法进行标准成像的情况下具有临床应用价值。未来的研究应调查超声参数，以提高诊断颅内病变的准确性。
