Evidence map›Paper›PMID 42902103›Full record

ReviewNeurocritical care2026

Contrast-Enhanced NeuroPOCUS in Neurocritical Care: Overcoming Technical Barriers to Bedside Transcranial Ultrasound.

Amedeo Bianchini, Giovanni Malferrari, Andrea Zanoni, Giovanni Volpe, Cristina Felicani, Cecilia Modolon, Elena Zangheri

Abstract readReview
PubMed Publisher
In one paragraph

Review in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Amedeo BianchiniAnesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy. amedeo.bianchini@aosp.bo.it.ORCID http://orcid.org/0000-0002-4509-0586
Giovanni MalferrariNeurology and Neurosonology, Centro di Neuroscienze Anemos, Reggio Emilia, Italy.
Andrea ZanoniAnesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Giovanni VolpeAnesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Cristina FelicaniUOC Medicina ad Indirizzo Metabolico Nutrizionale, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41125, Modena, Italy.
Cecilia ModolonPediatric and Adult Cardio Thoracic and Vascular, Oncohematologic, and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Elena ZangheriAnesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Neuro-point-of-care ultrasound (NeuroPOCUS) is an emerging bedside modality that extends the neurological examination through real-time assessment of cerebral structure and hemodynamics in neurocritical care. Despite increasing integration into clinical pathways and endorsement of transcranial ultrasound-based neuromonitoring by international guidelines, implementation is often hampered by inadequate acoustic windows and poor image and Doppler signal quality, frequently leading to nondiagnostic examinations. Ultrasound contrast agents (UCAs), traditionally used in specialist neurosonology, may overcome these barriers and recover diagnostic information in patients with limited acoustic windows. This clinically oriented narrative review synthesizes the available evidence on contrast-enhanced transcranial ultrasound and examines its potential translation into NeuroPOCUS as a bedside tool for frontline clinicians across vasospasm monitoring, intracranial pressure assessment, evaluation of steno-occlusive cerebrovascular disease, assessment of cerebral circulatory arrest, and other neurocritical care applications. A literature search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, and Scopus was conducted through June 2026, and relevant studies, reviews, and guideline documents were descriptively synthesized according to clinical application. Available evidence indicates that UCAs improve Doppler signal quality, enhance visualization of intracranial vessels, and increase the proportion of diagnostic examinations in patients with limited acoustic windows, thereby improving the interpretability of bedside hemodynamic assessments. However, implementation remains constrained by operator dependence, heterogeneous acquisition and interpretation protocols, limited standardization, and the need for structured training and validated, application-specific velocity cutoffs. Looking ahead, contrast enhancement may expand the scope of bedside neurovascular assessment, including in emergency and acute-care settings where dedicated probes and presets are not readily available. Its favorable safety profile and enhanced bedside feasibility may help bridge the gap between guideline recommendations and clinical practice, although further technical and clinical validation is needed to define its role in frontline NeuroPOCUS.

Indexed as

Contrast-enhanced ultrasound (CEUS)Neurocritical careNeuroPOCUSPoint-of-care ultrasound (POCUS)Transcranial color-coded duplex sonography (TCCD/TCCS)Ultrasound contrast agents

Identifiers

PMID42902103

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.