Transcranial ultrasound-CT fusion imaging is a promising advancement in bedside neurological assessment. By combining the real-time benefits of ultrasound with the detailed anatomical information of CT, it offers a non-invasive and precise tool but has not been explored in the neurological intensive care unit (NICU).

In an observational study conducted at the Hospices Civils de Lyon, France, we explored this technology in seven NICU patients. Two registration methods for ultrasound-CT fusion were tested: manual alignment using anatomical landmarks and automatic registration with the use of a CT-compatible tracker. The first method provided highly accurate alignment but required experienced operators, while the second method was faster and more practical for bedside use, despite challenges in maintaining head stage positioning. Ultrasound-CT fusion allowed real-time 3D visualization of intracranial structures, including non-conventional imaging planes such as coronal views. This study suggests that ultrasound-CT fusion is a feasible and valuable technique in the NICU, with the potential to improve diagnostic precision, bedside monitoring, and resident training.