• Benjamin R Wakerley, Yohanna Kusuma, Leonard L L Yeo, Shen Liang, Komal Kumar, Arvind K Sharma, and Vijay K Sharma.
• Division of Neurology, National University Health System, Singapore.
• J Neuroimaging. 2015 Jan 1; 25 (1): 111-6.

BackgroundTranscranial Doppler (TCD) ultrasonography is a noninvasive bedside tool that can evaluate cerebral blood flow hemodynamics in major intracranial arteries. TCD-derived pulsatility index (PI) is believed to be influenced by intracranial pressure (ICP).ObjectiveTo correlate TCD-PI with cerebrospinal fluid (CSF) pressure (representing ICP), measured by standard lumbar puncture (LP) manometry.MethodsCSF pressures (CSF-P) were measured in 78 patients by LP manometry. Stable TCD spectra were obtained 5 minutes before LP from either middle cerebral arteries using Spencer's head frame and 2-MHz transducer. PI values were calculated from the TCD spectra by an independent neurosonologist.ResultsFactors displaying a significant relationship with CSF-P included age (R = -.426, P < .0005); EDV (R = -.328, P = .002;) and PI (R = .650, P < .0005). On analyzing dichotomized data (CSF-P < 20 vs. ≥ 20 cm H2 0) TCD-PI was an independent determinant (OR per .1 increase in PI = 2.437; 95% CI, 1.573-3.777; P < .0005). PI ≥ 1.26 could reliably predict CSF-P ≥ 20 cm H2 0 (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 81.1%, 96.3%, 93.8%, 88.1%, and 90.1% respectively).ConclusionTCD-derived PI could be used to identify patients with CSF-P ≥ 20 cm H2 0 and may play an important role as a monitoring tool.Copyright © 2014 by the American Society of Neuroimaging.

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