Year: 2026 | Month: July | Volume: 16 | Issue: 7 | Pages: 266-279
DOI: https://doi.org/10.52403/ijhsr.20260728
Comparison of Transcranial Sonography with Computed Tomography of the Brain in Post-craniectomy Patients for Acquired Brain Injury
Bernice Thamarai Selvi1, Goldwin Helancecil1, Priyadharshini Muthiah1, Judy Ann John2, Naveen Cherian Thomas2
1Department of Clinical Radiology, 2Department of Physical Medical and Rehabilitation, Christian medical College, Vellore, India.
Corresponding Author: Dr. Bernice Thamarai Selvi
ABSTRACT
Background: Decompressive craniectomy is the treatment of choice to relieve raised intracranial pressure in patients with moderate to severe brain injury secondary to stroke and trauma. Computed Tomography (CT) scan is the standard test for monitoring complications in these patients; however, it poses concerns for cumulative radiation and transport risks of the critically ill. Transcranial sonography (TCS) can be an adjunct modality for a quick interim bedside assessment. It is rapid, cost-effective and radiation-free. Several studies have demonstrated that TCS provides a good description of these complications and is comparable to CT scan.
Objectives:
(1) To assess the degree of concordance between TCS and CT scan of the brain in post-craniectomy patients for acquired brain injury.
(2) To assess the diagnostic accuracy of TCS in this cohort.
(3) To describe the technical feasibility and challenges in performing TCS in this cohort.
Materials and methods: In this prospective diagnostic study, 35 patients who underwent decompression craniectomy for acquired brain injury and had a CT scan of the brain as part of routine clinical work-up were included. TCS were performed via craniectomy flap on the same day as the reference CT scan. Investigators were blinded to the CT findings. Various parameters were assessed and compared with CT for concordance and for diagnostic accuracy.
Results: Midline shift was seen in 8.6% and perfect diagnostic agreement was achieved between the two modalities (k=1.00, p<0.001). Almost perfect agreement was observed for ventriculomegaly (κ=0.819). Both modalities demonstrated 100% consensus for parenchymal gliosis, basal cistern patency, and interhemispheric collections. Subdural collections were seen in 20%, and hemorrhagic lesions in 5.7% on both modalities.
Third & fourth ventricular measurements also showed high degree of absolute agreement with no significant inter-modality bias. For ventricular and index metrics, ICC was > 0.97, Bland-Altman analysis showed no significant systematic bias. For ventriculomegaly, TCS demonstrated 92.3% sensitivity, 90.9% specificity, and a Youden Index of 0.832 and for midline shift, TCS achieved 100% sensitivity, 100% specificity, and a Youden Index of 1.0.
Conclusion: Although TCS cannot replace CT, with the given concordance, we conclude that TCS is a reliable, cost-effective adjunct tool for interim and quick evaluation of critically-ill craniectomised patients and in a resource-limited setting.
Key words: transcranial sonography, post-craniectomy, acquired brain injury, midline shift, ventriculomegaly.