Transcranial ultrasonography to detect intracranial pathology: A systematic review and meta-analysis

Beddome C. Allen, Sahil Kapoor, Anthony Anzalone, Kirby P. Mayer, Stacey Q. Wolfe, Pam Duncan, Andrew W. Asimos, Ralph D'Agostino, James Tripp Winslow, Aarti Sarwal

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background and Purpose: Transcranial ultrasonography (TCU) can be a useful diagnostic tool in evaluating intracranial pathology in patients with limited or delayed access to routine neuroimaging in critical care or austere settings. We reviewed available literature investigating the diagnostic utility of TCU for detecting pediatric and adult patient's intracranial pathology in patients with intact skulls and reported diagnostic accuracy measures. Methods: We performed a systematic review of PubMed®, Cochrane Library, Embase®, Scopus®, Web of Science™, and Cumulative Index to Nursing and Allied Health Literature databases to identify articles evaluating ultrasound-based detection of intracranial pathology in comparison to routine imaging using broad Medical Subject Heading sets. Two independent reviewers reviewed the retrieved articles for bias using the Quality Assessment of Diagnostic Accuracy Studies tools and extracted measures of diagnostic accuracy and ultrasound parameters. Data were pooled using meta-analysis implementing a random-effects approach to examine the sensitivity, specificity, and accuracy of ultrasound-based diagnosis. Results: A total of 44 studies out of the 3432 articles screened met the eligibility criteria, totaling 2426 patients (Mean age: 60.1 ± 14.52 years). We found tumors, intracranial hemorrhage (ICH), and neurodegenerative diseases in the eligible studies. Sensitivity, specificity, and accuracy of TCU and their 95% confidence intervals were 0.80 (0.72, 0.89), 0.71 (0.59, 0.82), and 0.76 (0.71, 0.82) for neurodegenerative diseases; 0.88 (0.74, 1.02), 0.81 (0.50, 1.12), and 0.94 (0.92, 0.96) for ICH; and 0.97 (0.92, 1.03), 0.99 (0.96, 1.01), and 0.99 (0.97, 1.01) for intracranial masses. No studies reported ultrasound presets. Conclusions: TCU has a reasonable sensitivity and specificity for detecting intracranial pathology involving ICH and tumors with clinical applications in remote locations or where standard imaging is unavailable. Future studies should investigate ultrasound parameters to enhance diagnostic accuracy in diagnosing intracranial pathology.

Original languageEnglish
JournalJournal of Neuroimaging
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The study team acknowledges the support of institutional review board and other regulatory committees in adapting to the challenges imposed by the pandemic and allowing critical research to proceed when feasible during a challenging crisis. The abstract for this publication has been accepted by the NeuroCriticalCare Society and the European Society of Neurosonology and Cerebral hemodynamics. Aarti Sarwal's institution has received compensation for research support for her role as site investigator for conducting multicenter clinical trials from Bard, Biogen, Novartis, and CVR Global, Inc. In addition, they have received compensation from LungPacer, Inc and NIH/NIA R01 AG066910-01 (Brinkley/Shaltout) for her role as a consultant for ultrasound image analysis in clinical research trials. She has received honorarium, free meeting registration, and/or reimbursement of travel expenses for role as speaker at continuing medical education activities conducted by Society of Critical Care Medicine, Neurocritical Society, Indian Society of Critical Care Medicine, Indian Academy of Neurology, American Institute of Ultrasound in Medicine, Intensive Care Society, American College of Chest Physicians, American Thoracic Society, and American Association of Physical Therapists. The remaining authors declare no conflict of interest.

Publisher Copyright:
© 2023 The Authors. Journal of Neuroimaging published by Wiley Periodicals LLC on behalf of American Society of Neuroimaging.


  • brain mass
  • cranial ultrasound
  • intracranial hemorrhage
  • neurodegenerative disease
  • point of care ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


Dive into the research topics of 'Transcranial ultrasonography to detect intracranial pathology: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this