• Pasquale De Bonis, Giorgio Mantovani, Giorgio Lofrese, Michele Alessandro Cavallo, Giorgia Valpiani, Chiara Morotti, and Alba Scerrati.
• Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.
• J Neuroimaging. 2020 Nov 1; 30 (6): 800-807.

Background And PurposeComputed tomography (CT) is the actual gold standard diagnostic tool for monitoring patients after decompressive craniectomy. It is validated and provides a wide number of information. However, it takes time, expensive, and requires patient transportation. Transcranial sonography (TCS) could represent an alternative diagnostic tool in these patients. The aim of this study is to compare TCS versus CT scan after decompressive craniectomy in terms of diagnosing complications and costs evaluation.MethodsWe prospectively enrolled 10 craniectomized patients who were monitored with sonography and CT. Ventricular measurements and possible complications were evaluated by two independent observers. The two methods were compared using Fisher's exact test and Spearman's Rho coefficient. A costs analysis was also conducted.ResultsA good correlation coefficient (ρ) between CT and TCS was found for frontal horn dimensions (ρ .9929), median cella (ρ .9516), and third ventricle (ρ .8989). All results were statistically significant (P < .0001) and Bland-Altman plots showed no systemic biases. Fisher's exact test showed no statistically significant differences between TCS and CT for all the studied predefined complications. Cost analysis showed a 68% cost reduction in favor of TCS.ConclusionsTCS could be a reliable alternative diagnostic tool for major complications in patients undergoing decompressive craniectomy. It could limit the number of CT scans per patient overcoming several limitations, such as costs, radiation exposure, and need to move the patient.© 2020 American Society of Neuroimaging.

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