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<p>Cerebral microcirculation critically determines tissue viability and recovery in neurocritical disorders, yet bedside assessment remains unavailable, forcing intuition-based clinical decisions. Here, in this prospective observational study of 20 patients with traumatic brain injury following decompressive craniectomy, we show that ultrasound localization microscopy (ULM) enables bedside cerebral microvascular assessment in neurocritical care. Conventional ULM requires ultrafast imaging, limiting clinical translation; here we overcome this by implementing an efficient multihypothesis, multiframe global-optimization algorithm suitable for a clinical system, achieving ~139 μm resolution (~1/4 wavelength). Longitudinal imaging on postoperative days 3 and 14 revealed severity-dependent remodelling: moderate injuries demonstrated superior structural recovery, whereas severe cases exhibited higher early vascular resistance and persistent flow deficits. Furthermore, composite ULM metrics correlated negatively with invasive intracranial pressure, and the microvascular perfusion efficiency coefficient robustly stratified 6-month outcomes. These results establish ULM as a clinically translatable bedside platform for microcirculation-guided neurocritical care.</p>

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Clinically translatable ultrasound localization microscopy reveals cerebrovascular remodelling and prognosis in patients with traumatic brain injury

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Maoyao Li,
  • Wenxuan Wang,
  • Ziyang Su,
  • Jingjing Wu,
  • Yang Yang,
  • Longchen Wang,
  • Yi Wang,
  • Mickaël Tanter,
  • Zeng Zhang,
  • Fang Yuan,
  • Yuanyi Zheng

摘要

Cerebral microcirculation critically determines tissue viability and recovery in neurocritical disorders, yet bedside assessment remains unavailable, forcing intuition-based clinical decisions. Here, in this prospective observational study of 20 patients with traumatic brain injury following decompressive craniectomy, we show that ultrasound localization microscopy (ULM) enables bedside cerebral microvascular assessment in neurocritical care. Conventional ULM requires ultrafast imaging, limiting clinical translation; here we overcome this by implementing an efficient multihypothesis, multiframe global-optimization algorithm suitable for a clinical system, achieving ~139 μm resolution (~1/4 wavelength). Longitudinal imaging on postoperative days 3 and 14 revealed severity-dependent remodelling: moderate injuries demonstrated superior structural recovery, whereas severe cases exhibited higher early vascular resistance and persistent flow deficits. Furthermore, composite ULM metrics correlated negatively with invasive intracranial pressure, and the microvascular perfusion efficiency coefficient robustly stratified 6-month outcomes. These results establish ULM as a clinically translatable bedside platform for microcirculation-guided neurocritical care.