What question did this study set out to answer?

The study aims to evaluate the reliability of TCCD-derived MCA-PI for predicting ICP in brain injury patients at high altitudes.

March 16, 2026Open Access

Value of transcranial color-coded duplex sonography-derived middle cerebral artery pulsatility index in intracranial pressure assessment at moderate to high altitudes

Key Points

The study aims to evaluate the reliability of TCCD-derived MCA-PI for predicting ICP in brain injury patients at high altitudes.
Clinical data were collected from patients in an ICU on the Qinghai-Tibet Plateau.
Data included 158 sets of MCA-PI and ICP from 54 patients from April to July 2025.
A Spearman's correlation analysis was conducted to evaluate relationships between MCA-PI and ICP.
A generalized estimating equation was developed to predict non-invasive intracranial pressure based on MCA-PI.
MCA-PI was significantly correlated with ICP (r = 0.769, P < 0.001).
For MCA-PI > 1.21, sensitivity was 0.850, specificity was 0.936, and ROC AUC was 0.916 (P < 0.001).
MCA-PI serves as a non-invasive and cost-effective tool for assessing elevated ICP in moderate-to-high altitude settings.

Abstract

To assess transcranial color-coded duplex sonography (TCCD) as a reliable method for predicting intracranial pressure (ICP) in brain injury patients at moderate-to-high-altitude, clinical data were collected from patients admitted to the Intensive Care Unit of a tertiary hospital on the Qinghai-Tibet Plateau between April 24 and July 24, 2025. A total of 158 sets of middle cerebral artery pulsatility index (MCA-PI) and ICP data from 54 patients were included. The median PI, ICP, and arterial carbon dioxide partial pressure (PaCO2) were 1.19 (0.99, 1.42), 15.08 (13.61, 17.10) mmHg, and 36.00 (33.00, 40.13) mmHg, respectively. Spearman's analysis showed a strongly positive PI-ICP correlation (r = 0.769, P 1.21 predicting ICP > 15 mmHg, sensitivity, specificity, and ROC AUC were 0.850, 0.936, and 0.916 (95% CI: 0.868-0.963, P < 0.001), respectively. MCA-PI correlates with ICP and aids in identifying elevated ICP; this non-invasive, low-cost method is suitable for moderate-to-high altitude areas.

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