![]() Time-averaged mean velocity is not recorded in ( a), but is shown in ( b) as TAM, traced in the middle of the Doppler spectra (white arrow). There is also no doubt in a that is TAP, because pulsatility index (PI) is calculated using this value. ![]() As depicted from the trace of the envelope of the Doppler spectra (yellow arrows), time-averaged maximum velocity is recorded, namely, TAV (time-averaged velocity) in ( a) and TAP (time-averaged peak velocity) in ( b). Note the different and confusing nomenclature regarding “mean velocities”. Particularly in patients with a decompressive craniectomy, an alternative MLS measurement technique is well validated against CT. ![]() Practitioners should be aware that the MLS measurement by TCCS is not reliable in the presence of bone defects (like decompressive craniectomy or skull fractures), temporal cephalohematoma, or changes in intracranial anatomy secondary to trauma, citing the most common examples observed in daily practice. To the authors´ knowledge, whether methodologically correct or not, there are no study validating either of them. 1 of the original article, measuring the distance to the contralateral cranial bone is not described in the original technique, it is unnecessary and adds complexity thus, it should not be taken into account, as is the case with the mentioned “C and D” technique. While proposed by authors’ as an “internal standard”, as shown in Fig. ![]() In the first place, regarding the midline shift (MLS) measurement technique by TCCS, (A-B)/2 is well-studied and validated against CT. ![]()
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