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. 2014 Dec 9;18(6):676.
doi: 10.1186/s13054-014-0676-9.

Assessment of brain midline shift using sonography in neurosurgical ICU patients

Julie Motuel  1 , Isaure Biette  2 , Mohamed Srairi  3 , Ségolène Mrozek  4 , Matt M Kurrek  5 , Patrick Chaynes  6 , Christophe Cognard  7 , Olivier Fourcade  8 , Thomas Geeraerts  9
Affiliations

Assessment of brain midline shift using sonography in neurosurgical ICU patients

Julie Motuel et al. Crit Care. .

Abstract

Introduction: Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. We aimed to validate bedside assessment of MLS with Transcranial Sonography (TCS) in neurosurgical ICU patients by comparing it to CT.

Methods: In this prospective single centre study, patients who underwent a head CT were included and a concomitant TCS performed. TCS MLS was determined by measuring the difference between the distance from skull to the third ventricle on both sides, using a 2 to 4 MHz probe through the temporal window. CT MLS was measured as the difference between the ideal midline and the septum pellucidum. A significant MLS was defined on head CT as > 0.5 cm.

Results: A total of 52 neurosurgical ICU patients were included. The MLS (mean ± SD) was 0.32 ± 0.36 cm using TCS and 0.47 ± 0.67 cm using CT. The Pearson's correlation coefficient (r(2)) between TCS and CT scan was 0.65 (P < 0.001). The bias was 0.09 cm and the limits of agreements were 1.10 and -0.92 cm. The area under the ROC curve for detecting a significant MLS with TCS was 0.86 (95% CI = 0.74 to 0.94), and, using 0.35 cm as a cut-off, the sensitivity was 84.2%, the specificity 84.8% and the positive likelihood ratio was 5.56.

Conclusions: This study suggests that TCS could detect MLS with reasonable accuracy in neurosurgical ICU patients and that it could serve as a bedside tool to facilitate early diagnosis and treatment for patients with a significant intracranial mass effect.

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Figures

Figure 1
Figure 1
Example of visualisation of the third ventricle with brain sonography, the arrow pointing to the centre of the third ventricle.
Figure 2
Figure 2
Example of MLS measure with CT scan: on the left, method 1 (in the same plane as sonography through the third ventricle), and on the right, method 2 (measuring the distance between the ideal median line and the septum pellucidum). CT, computed tomography; MLS, midline shift.
Figure 3
Figure 3
Correlation between sonography and CT method 1 for MLS assessment. CT, computed tomography; MLS, midline shift.
Figure 4
Figure 4
Correlation between sonography and CT method 2 for MLS assessment. CT, computed tomography; MLS, midline shift.
Figure 5
Figure 5
Bland and Altman plot for the agreement between sonography and CT method 1 for MLS assessment. CT, computed tomography; MLS, midline shift.
Figure 6
Figure 6
Bland and Altman plot for the agreement between sonography and CT method 2 for MLS assessment. CT, computed tomography; MLS, midline shift.
Figure 7
Figure 7
Receiver operating characteristic curve for the detection of a CT MLS >0.5 cm (method 2) with TCS. CT, computed tomography; MLS, midline shift; TCS, transcranial sonography.
See this image and copyright information in PMC

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