Department of Neurology and Neurocritical Care Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
, Shmuel Bait Street, 9103102, Jerusalem, Israel.
Neurocrit Care. 2024 Apr;40(2):562-567. doi: 10.1007/s12028-023-01784-4. Epub 2023 Jul 6.
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.
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.
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.
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.
尽管在中风治疗方面取得了突破，但仍有一些患者出现大脑半球大面积梗死，导致颅内压升高和组织移位。目前，颅内压升高的演变情况通过连续的计算机断层扫描（CT）成像进行监测。然而，有些患者不适合转运，而且床边监测单侧组织移位的选择有限。
我们使用经颅彩色双功超声与 CT 血管造影融合成像。这种方法允许将实时超声叠加在 CT 或磁共振成像扫描上。符合条件的患者为大脑半球大面积梗死患者。从源文件中获取位置数据，并与实时图像匹配，同时与患者额头上的磁探头和超声探头相关联。分析脑实质移位、大脑前动脉、基底动脉和第三脑室的移位，以及中脑受压和基底动脉在头部的移位情况。除了接受 CT 成像的标准治疗外，患者还接受了多次检查。
融合成像诊断 3 毫米移位的敏感度为 100%，特异性为 95%。未记录到任何副作用或与重症监护设备的相互作用。
融合成像为重症监护患者提供了一种易于获取的方法，可用于测量组织和血管移位，并可对中风后进行随访。融合成像可能是决定是否行去骨瓣减压术的重要依据。
