(715) CUPID: Comprehensive Protocol for Ultrasound-Based Diagnosis of Intracranial Pathology

Introduction: Cranial ultrasound is being increasingly investigated in point of care applications for evaluation of acute neurological emergencies in austere or resource limited settings where CT or MRI is not available. Recent publications have highlighted pitfalls in sensitivity/specificity of axial section cranial B mode ultrasound imaging. We propose use of both axial and coronal images in temporal windows and adding frontal windows to increase the accuracy of B mode ultrasound in diagnosis of intracranial pathology.

Methods: After IRB approval, 43 patients admitted to the neuroICU at a tertiary level medical center were screened for inclusion over 21 days as part of the Medical Student Research Program. 22 eligible patients were consented, with 28 cranial ultrasound scans obtained. All scans were performed within 24 hours of head CT scans performed as part of routine care. B-mode cranial ultrasounds were obtained in temporal and frontal windows in axial and coronal views by scanning caudally to cranially and from anterior to posterior respectively. All images were reviewed post hoc and compared to respective CT scan anatomy by blinded senior investigator (AS).

Results: 9 of 16 intracranial hemorrhages (ICH) were identified correctly on ultrasound. False negative results were seen in subdural hematomas, subarachnoid hemorrhages, and a temporal venous hemorrhage. Other intracranial abnormalities identified on ultrasound include blood products within a tumor resection cavity and ventriculostomy catheters. Blinded analysis by senior investigator showed similar sensitivity and specificity to unblinded interpretation by the medical student.

Conclusions: Image acquisition incorporating both axial and coronal section on temporal & frontal windows increases the accuracy of B mode ultrasound. Further investigations will help evaluate clinical translation of patient population where B mode ultrasound can help screen patients for intracranial pathology where CT/MRI is not accessible.