Automatic Calculation of the Rheoencephalographic Pulse Wave Peaks
The First Results
DOI:
https://doi.org/10.21467/ijm.4.1.9492Abstract
To create an algorithm to detect rheoencephalographic (REG) pulse wave second peak increase, which may detect an increase in intracranial pressure (ICP). REG was measured in 19 healthy volunteers during control and a 15-degree head-down tilt (HDT), which caused an increase in ICP. We developed an algorithm for automatically calculating P1 and P2 from the REG pulse waveform. The result was compared to manual measurements during control and HDT positions. The automatic determination of the peaks’ time instants was considered a series of two-class decision problems in ±15-ms-wide sliding decision windows. We achieved an accuracy of 0.9826, a sensitivity of 0.7727, and a specificity of 0.9902. We used the correlation coefficient between manual measurements and automated data and the normalized mean absolute error (NMAE) metric to characterize the precision of peak amplitude value estimation. We achieved a high correlation (> 0.8) in 92% of all tests, and NMAE < 0.3 in 96%. The remaining cases were analyzed using Bland-Altman plots to uncover the main causes of differences. We tested the hypothesis of increasing P2 peak amplitude during HDT compared to the control position. In the female group, the number of significant increases was 4 out of 6 (67%), both in manual and automatic measurements. In the case of the male group’s manual measurements, 12 of 13 (92%), and the automatic calculation gave 10 of 13 (77%). The significance is to switch from invasive ICP to noninvasive REG to have the same information for decision-making at the bedside to save the lives of neurocritical care patients. Future REG correlation studies suggested using REG in neurocritical care monitoring, space research, and military medical practice.
Keywords:
Pulse wave morphology, Rheoencephalogram, NoninvasiveDownloads
References
Hawryluk G.W.J, Citerio G. et al (2022) Intracranial pressure: current perspectives on physiology and monitoring. Intensive Care Med. 48:1471-1481. https://doi.org/10.1007/s00134-022-06786-y
Shim Y, Kim J, Kim HS, Oh J, Lee S, Ha EJ (2023) Intracranial Pressure Monitoring for Acute Brain Injured Patients: When, How, What Should We Monitor. Korean J Neurotrauma. 28;19(2):149-161. https://doi.org/10.13004/kjnt.2023.19.e32
Depreitere B, Meyfroidt G, Güiza F (eds) (2021) Intracranial Pressure and Neuromonitoring XVII. Acta Neurochirurgica Supplement (NEUROCHIRURGICA, volume 131). Springer, https://doi.org/10.1007/978-3-030-59436-7
Chesnut R, Aguilera S, Buki A et al (2020) A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 46:919-929. https://doi.org/10.1007/s00134-019-05900-x.
Le Roux P, Menon DK, Citerio G et al (2014) The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a list of recommendations and additional conclusions: A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care. 21: S282-96. https://doi.org/10.1007/s12028-014-0077-6. 38
Link C.D, Haese T.M, Frigieri G, Brasil S, Vellosa J.C.R, Welling L. (2023) Intracranial compliance and volumetry in patients with traumatic brain injury. Surg Neurol Int.14:246; 1-6. https://doi.org/10.25259/SNI_314_2023
Czosnyka M, Czosnyka Z. (2020) Origin of intracranial pressure pulse waveform. Acta Neurochir (Wien) 162:1815-1817. https://doi.org/10.1007/s00701-020-04424-4
Germon K. (1988) Interpretation of ICP pulse waves to determine intracerebral compliance J. Neurosci. Nurs. 20 344–51
Ellis T, McNames J, Aboy M (2007) Pulse morphology visualization and analysis with applications in cardiovascular pressure signals. IEEE Trans Biomed Eng 54:1552-9 https://doi.org/10.1109/TBME.2007.892918
Godoy DA, Brasil S, Iaccarino C, Paiva W, Rubiano AM (2023) The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management. Crit Care.27:137:1-9. https://doi.org/10.1186/s13054-023-04427-4
Cucciolini, G, Motroni, V. & Czosnyka, M (2023) Intracranial pressure for clinicians: it is not just a number. J Anesth Analg Crit Care 3-31:1-13 https://doi.org/10.1186/s44158-023-00115-5
Kasprowicz M, Asgari S, Bergsneider M, Czosnyka M, Hamilton R, Hu X. (2010) Pattern recognition of overnight intracranial pressure slow waves using morphological features of intracranial pressure pulse. J Neurosci Methods 15:190:310-8. https://doi.org/10.1016/j.jneumeth.2010.05.015
Mataczynski C, Kazimierska A, Uryga A, Burzynska M, Rusiecki A, Kasprowicz M (2022) End-to-End Automatic Morphological Classification of Intracranial Pressure Pulse Waveforms Using Deep Learning. IEEE J Biomed Health Inform. 26:494-504. https://doi.org/10.1109/JBHI.2021.3088629
Pérez-Sánchez J, Carrillo de Gea J.M. et al (2021) Intracranial pressure analysis software: A mapping study and proposal. Comput Methods Programs Biomed. 209:106334. https://doi.org/10.1016/j.cmpb.2021.106334
Uryga A, Ziółkowski A, Kazimierska A. et al (2022) CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators; CENTER-TBI High-Resolution Sub-Study Participants and Investigators. Analysis of intracranial pressure pulse waveform in traumatic brain injury patients: a CENTER-TBI study. J Neurosurg. 23;139:201-211. https://doi.org/10.3171/2022.10.JNS221523
Brasil S. (2022) Intracranial pressure pulse morphology: the missing link? Intensive Care Med. 48:1667-1669. https://doi.org/10.1007/s00134-022-06855-2
brain4care (Brain4care Corp., São Carlos, Brazil) https://brain4.care/en/solution/
Brasil S, Frigieri G, Taccone F.S. (2023) Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients. J Clin Monit Comput. 37:753-760. https://doi.org/10.1007/s10877-022-00941-y
Kazimierska A, Manet R, Vallet A et al (2023). Analysis of intracranial pressure pulse waveform in studies on cerebrospinal compliance: a narrative review. Physiol Meas. 4410TR01:1-20. https://doi.org/10.1088/1361-6579/ad0020
Brasil S, Solla DJF, Nogueira RC et al, (2021) A Novel Noninvasive Technique for Intracranial Pressure Waveform Monitoring in Critical Care. J Pers Med. 11:1302. https://doi.org/10.3390/jpm11121302
ICM+: Intensive care Monitoring program. https://icmplus.neurosurg.cam.ac.uk/
Anonymous (1997) Rheoencephalograph (a) Identification Code of Federal Regulations Title 21, vol 8, Sec 882.1825, Washington DC: US Government Printing Office; Revised as of April 1, 1997.
Jenkner FL (1986) Clinical rheoencephalography: a noninvasive method for automatic evaluation of cerebral hemodynamics. Ertldruck, A-6000, Vienna
McHenry LC (1965) Rheoencephalography: a clinical appraisal. Neurology 15:507-17. https://doi.org/10.1212/WNL.15.6.507
Bodo M, Garcia A, Pearce F, vanAlbert S, Armonda R (2010) Influence of volume and change on the electrical impedance signal (in vitro). J. Phys.: Conf. Ser. 22 012111 https://doi.org/10.1088/1742-6596/224/1/012111
Bodo M, Racz J, Ilias L, et al (1986) Rheoencephalographic changes during increased intracranial pressure. In: Krieglstein J. (ed) Pharmacology of Cerebral Ischemia. Elsevier, Amsterdam, pages 265-269. LC : 86029027, ISBN : 0444808450, ISBN : 9780444808455
Bodo M, Simovic M, Pearce F, Ahmed A, Armonda R (2015) Correlation of rheoencephalogram and intracranial pressure: results of a rat study. Physiol. Meas. 36; N115-N126. http://dx.doi.org/10.1088/0967-3334/36/10/N115
Cannizzaro L.A., Iwuchukwu I, Rahaman V, Hirzallah M, Bodo M. (2023) Noninvasive neuromonitoring with rheoencephalography: a case report. J Clin Monit Comput. 19:1–10. https://doi.org/10.1007/s10877-023-00985-8
Moskalenko Y.E. (ed) (1980) Biophysical Aspects of Cerebral Circulation. Pergamon, Oxford, ISBN 0-08-022672-8
Bodo M. (2010) Studies in rheoencephalography (REG). J Electr Bioimp, 1:18–40. DOI: https://doi.org/10.5617/jeb.109
Bodo M. (2020) A noninvasive, continuous brain monitoring method: rheoencephalography (REG) DRC Sustainable Future 1:94-110. https://doi.org/10.37281/DRCSF
Szabo S, Totka Z, Nagy-Bozsoky J, Pinter I, Bagany M, Bodo M. Rheoencephalography: A non-invasive method for neuromonitoring. J Electr Bioimpedance. 2024 Mar 13;15(1):10-25. doi: 10.2478/joeb-2024-0003.
Acharya J.N., Hani AJ, Cheek J, Thirumala P, Tsuchida T.N. (2016) American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature. Neurodiagn J. 56:245-252. https://doi.org/10.1080/21646821.2016.1245558
Baranyi L, Dannie M, Hooftalle K, Pearce FJ, Bodo M. DataLyser program. https://doi.org/10.13140/RG.2.2.21169.25442
MATLAB Mathworks, Natick, MA. https://www.mathworks.com/products/new_products/latest_features.html
Scholkmann F, Boss J, and Wolf M. (2012) An Efficient Algorithm for Automatic Peak Detection in Noisy Periodic and Quasi-Periodic Signals. Algorithms 5:588-603; https://doi.org/10.3390/a5040588
Bishop S, Ercole A (2018) Multiscale Peak and Trough Detection Optimized for Periodic and Quasi-Periodic Neuroscience Data. Acta Neurochirurgia Suppl. 126:189-195. https://doi.org/10.1007/978-3-319-65798-1_39
Fawcett T. An introduction to ROC analysis. Pattern Recognition Letters. 27 (2006) pp. 861-874. https://doi.org/10.1016/j.patrec.2005.10.010
Bland J.M., Altman D.G. (1999) Measuring agreement in method comparison studies. Statistical Methods in Medical Research 1999; 8: 135 – 160
de Moraes F.M., Rocha E, Barros F.C.D. (2022) Waveform Morphology as a Surrogate for ICP Monitoring: A Comparison Between an Invasive and a Noninvasive Method. Neurocrit Care. 37:219-227. https://doi.org/10.1007/s12028-022-01477-4
Poupko B.Z, Reichman Y, Rappaport A, Ben-Ari S. (2013) Noninvasive intracranial monitor. US patent. US 2013/0109979 A1. US20070287899A1 - Non-Invasive Intracranial Monitor - Google Patents https://patents.google.com/patent/US20070287899A1/en
Boraschi A, Spiegelberg A. et al (2023) The effect of body position change on noninvasively acquired intracranial pulse waves. Physiol Meas. 44(3). https://doi.org/10.1088/1361-6579/acc3d6
Shtok V.N. (1971) Povysheie vnutricherepnogo davleniia i diagnosticheskie vozmozhnosti reoéntsefolografii [Increased intracranial pressure and the diagnostic possibilities of rheoencephalography]. Vopr Neirokhir. 35:21-4. Russian. PMID: 5570270
Sokolov V.I. (1985) Sostoianie gemodinamiki i zheludochkovoĭ sistemy golovnogo mozga pri antiortostaticheskom vozdeĭstvii -15 gradusov [Hemodynamic and cerebral ventricular functions during head-down tilt at -15 degrees]. Kosm Biol Aviakosm Med. 19:39-42. Russian. PMID: 3990231
Iarullin Kh. Kh, Gornago V.A, Vasil'eva T.D, Gugushvili M.E. (1980) Izuchenie prognosticheskoĭ znachimosti antiortostaticheskoĭ nagruzki [Prognostic importance of the head-down tilting load]. Kosm Biol Aviakosm Med. 14:48-54. Russian. PMID: 7382406
Moskalenko Yu. E, Beketov A.I. et al (1991) The involvement of cerebrovascular reactivity in pathogenesis of space motion sickness. Acta Astronaut. 23:97-103. https://doi.org/10.1016/0094-5765(91)90104-d
Matsnev E.I., Iakovleva I.I. et al (1990) Osobennosti techeniia bolezni dvizheniia pri dlitel'noĭ otolitovoĭ stimuliatsii v antiortostaticheskom polozhenii [Characteristics of motion sickness during prolonged otolith stimulation in anti-orthostatic position]. Vestn Otorinolaringol. 1:8-14. Russian. PMID: 2316129.
Sheel A.W., Romer L.M. (2012) Ventilation and respiratory mechanics. Compr. Physiol. 2:1093-142. https://doi.org/10.1002/cphy.c100046
Perez J.J. (2014) To what extent is the bipolar rheoencephalographic signal contaminated by scalp blood flow? A clinical study to quantify its extra and nonextracranial components. Biomed Eng Online. 13 -131;1-11 https://doi.org/10.1186/1475-925X-13-131
Barrit S, E., Hadwe S, A., Barajraji M, Torcida N, Bogossian E.G, André J, Niset A, Carron R, Taccone F.S, Madsen J. Complications of Intracranial Multimodal Monitoring for Neurocritical Care: A Systematic Review and Meta-Analysis. Neurocrit Care. 2024 Jun;40(3):1182-1192. https://doi.org/10.1007/s12028-023-01885-0.
Wei M, Krakauskaite S, Subramanian S, Scalzo F. Peak detection in intracranial pressure signal waveforms: a comparative study. Biomed Eng Online. 2024 Jun 24;23(1):61. https://doi.org/10.1186/s12938-024-01245-9. PMID: 38915091; PMCID: PMC11194974.
Brady K.M., Mytar J.O., Kibler K.K. et al (2010) Monitoring cerebrovascular pressure reactivity with rheoencephalography. J. Phys.: Conf. Ser. 224 012089 https://doi.org/10.1088/1742-6596/224/1/012089
Montgomery LD, Montgomery RW, Bodo M, Mahon RT, Pearce FJ. Thoracic, Peripheral, and Cerebral Volume, Circulatory and Pressure Responses to PEEP During Simulated Hemorrhage in a Pig Model: a Case Study. J Electr Bioimpedance. 2021 Dec 27;12(1):103-116. doi: 10.2478/joeb-2021-0013.
Chang JJ, Gensler R, Armonda RA, Bodo M. Validation Studies on a Noninvasive Neuromonitoring Method, Rheoencephalography - A Review. Clinical Neuroscience - 2025;79 In print
Claassen JAHR, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021 Oct 1;101(4):1487-1559. doi: 10.1152/physrev.00022.202.
Barnes JN. Sex-specific factors regulating pressure and flow. Exp Physiol. 2017 Nov 1;102(11):1385-1392. doi: 10.1113/EP086531.
Bögli SY, Beqiri E, et al. Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights from cases, events, and patterns. Crit Care. 2025 Mar 31;29(1):139. doi: 10.1186/s13054-025-05360-4.
NASA Technology Readiness Levels - NASA Earth Science and Technology Office https://esto.nasa.gov/trl/
Bodo M, Thuroczy G, Nagy I, Peredi J, Sipos K, Harcos P, Nagy Z, Voros J, Zoltay L, Ozsvald L. A complex cerebrovascular screening system (CERBERUS). Med Prog Technol. 1995 May;21(2):53-66. PMID: 7565396.
Bodo M, Pearce FJ, Tsai MCD, Garcia A, vanAlbert S, Armonda R. Cessation of vital signs monitored during lethal hemorrhage: a Swine study. J Spec Oper Med. 2013 Winter;13(4):63-75. doi: 10.55460/20NR-BE1R.
Meghdadi AH, Popovic D, Rupp G, Smith S, Berka C, Verma A. Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE J Transl Eng Health Med. 2019 Feb 11;7:2700107. doi: 10.1109/JTEHM.2019.2898193
Kas'yan II, Vainshtein GB, Semernya VI, Gorokhov KA, Tikhonov VP, Ponomarev SI, Asanov KK. Pattern of blood circulation in the brain during rest and functional tests by Salyut-4 space crewmen. Biol Bull Acad Sci USSR. 1980 Mar-Apr;7(2):83-9. PMID: 7225468.
Bodo M, Szebeni J, Baranyi L, Savay S, Pearce FJ, Alving CR, Bünger R. Cerebrovascular involvement in liposome-induced cardiopulmonary distress in pigs. J Liposome Res. 2005;15(1-2):3-14. doi: 10.1081/lpr-64523.
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Copyright (c) 2026 Istvan Pinter, Mihaly Bagany, Sandor Szabo, Michael Bodo
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