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Contrast Enhanced Ultrasound Ventriculography.
MedLine Citation:
PMID:  22843135     Owner:  NLM     Status:  Publisher    
BACKGROUND:: During external ventricular drainage (EVD)-weaning, cranial computed tomography (cCT) is necessary to evaluate ventricle width. Because intra-hospital transfer of critically ill patients is associated with higher mortality, bedside techniques are necessary to evaluate ventricle width. Transcranial sonography is able to show the ventricles in patients with sufficient temporal acoustic window. Contrast enhanced ultrasound (CEUS) is able to overcome the limitations of insufficient insonation. OBJECTIVE:: We demonstrate the feasibility of bedside transcranial CEUS ventriculography to measure ventricles and verify the passage of cerebrospinal fluid (CSF) through the foramen of Magendie into the subarachnoid space during EVD-weaning in critically ill patients. METHODS:: Six patients were examined by transcranial and transnuchal CEUS. Harmonic imaging with low mechanical index was used. One millilitre of an ultrasound contrast agent was administered via EVD line. Comparison with the cranial CT scans at time of discharge was used to confirm CEUS-ventriculography results. RESULTS:: Ventricles were visualized in all patients. CSF transmission via the foramen of Magendie was demonstrated in five patients. Mean ventricle width (cm) was 0.67 (CEUS) vs. 0.73 (cCT) (SD 0.43,0.45,p=0.116) [3 ventricle], 0.88 vs. 1.02 (0.28,0.22, p=0.055) [4 ventricle], 1.40 vs. 1.37 (0.56,0.54,p=0.620) [left lateral ventricle], 1.37 vs. 1.37 (0.55,0.54, p=0.952) [right lateral ventricle], 2.33 vs. 2.23 (0.51,0.58,p=0.169) [left anterior horn], and 2.25 vs. 2.07 (0.56,0.64,p=0.204) [right anterior horn]. Mean duration for CEUS-ventriculography was 3:15 minutes. CONCLUSION:: CEUS-ventriculography is an effective bedside procedure in critically ill patients with EVD. CEUS allows measurement of ventricle width, ventricle communication, and CSF transfer to the subarachnoidal space through the cisternal foramina.
Andreas Becker; Daniela Kuhnt; Udo Bakowsky; Christopher Nimsky
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-26
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Dept. of Neurosurgery, University of Marburg, Germany 2Dept. of Pharmaceutical Technology and Biopharmaceutics, University of Marburg, Germany.
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