Transcranial sonographic monitoring of hemorrhagic transformation in patients with acute middle cerebral artery infarction

Background and Purpose. Previous studies indicate the potential of transcranial sonography (TCS) to detect cerebrovascular disease. The authors conducted this patient study to evaluate the diagnostic potential of gray-scale TCS in depicting hemorrhagic transformation (HT) in the early phase of middle cerebral artery infarction. Methods. TCS was performed in 32 patients with acute ischemic stroke in the middle cerebral artery territory less than 12, 24 4, 72 6, and 120 12 hours after symptom onset (SONOS 5500, S4 probe, 16 cm investigation depth). Hemorrhagic transformation was identified as hyperechogenicity in the MCA territory, and the echogenicity of these areas was assessed. In addition, the dislocation of the third ventricle (midline shift, MLS) was assessed by TCS. Size and localization of infarction were determined by cranial computed tomography (CCT). Results. In 10 of 11 patients, TCS detected HT as confirmed by CCT. In 1 patient, TCS provided a false-positive result. In another patient, TCS was unable to detect the hemorrhage (sensitivity, 91%; specificity, 95%). The echointensity of HT increased over time. MLS measurement failed to predict fatal outcome in 1 patient. Conclusions. TCS is a promising tool for depicting HT in patients with acute hemispheric stroke and might be suitable for monitoring purposes.