Clinical application of combined multimodal ultrasound monitoring for the risk of poor prognosis in patients with acute large cerebral infarction
LIU Jiao
LI Lin
DU Xiaoying
Abstract：Objective To develop and validate a bedside multimodal ultrasound-based combined prediction model for early risk stratification in patients with acute large hemispheric infarction.Methods In this prospective study,111 consecutive patients with acute large hemispheric infarction admitted to the Neuro-ICU of the First Affiliated Hospital of Bengbu Medical University from June 2024 to September 2025 were enrolled.Patients were categorized into two groups based on their modified Rankin Scale(mRS)score at 90 d,including favorable prognosis group(mRS score≤3,n=61)and poor prognosis group(mRS score>3,n=50).On the day of admission,the optic nerve sheath diameter(ONSD),eyeball transverse diameter(ETD),and transcranial color-coded Doppler(TCCD)parameters were measured.The ONSD/ETD ratio and the middle cerebral artery pulsatility index(PI)were calculated.Variables were selected using LASSO regression.A logistic regression combined model was constructed on a training set(70%of the cohort)and validated on an internal test set(30%).Model performance was comprehensively evaluated using the ROC curve,calibration analysis and decision curve analysis.Results The combined model(ONSD/ETD+PI)demonstrated good discriminative ability for predicting an unfavorable 90-day outcome(mRS>3)in the test set(AUC=0.855)and excellent calibration(Hosmer-Lemeshow test,P=0.982).Decision curve analysis indicated that the model provided significant net clinical benefit across a threshold probability range of 15%to 65%.Conclusion The multimodal ultrasound-based combined model developed in this study integrates intracranial"pressure-flow"information.It can effectively identify high-risk patients with acute large hemispheric infarction,and shows good calibration and clinical utility,which supports its potential as a quantitative bedside decision-support tool.
Keywords：optic nerve sheath diametereyeball transverse diametertranscranial color-coded Dopplermiddle cerebral arterylarge hemispheric infarctionintracranial pressurepulsatility indexprognosis
Publication Date：2026-02-20
Online Publishing Date：2026-03-25(First online date of this platform, not the publication date of the document)
Pages：7( 244-250 )