Transcranial Doppler Ultrasonography as a Diagnostic Tool for Cerebrovascular Disorders

Pan, Yuanmei; Wan, Wenbin; Xiang, Minjie; Guan, Yangtai

doi:10.3389/fnhum.2022.841809

Cited by 20 publications

(16 citation statements)

References 80 publications

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“…However, the use of TCD carries some limitations as operator dependency and possible inadequate acoustic window that could be frequently faced in older children, the more important issue in this context is that silent brain changes can develop even in presence of normal TCD study, and this could in turn evoke a paradigm shift regarding the guidelines of neuroimaging screening methods in SCD. In our study, we did not address the association of SCI with TCD, as TCD was not performed regularly in our institution due to logistic weakness (10)(11)(12)(13) .…”

Section: Discussionmentioning

confidence: 99%

Silent Brain Changes in Children with Sickle Cell Disease

Hashim¹,

Mokhtar²,

Allam³

2023

The Egyptian Journal of Hospital Medicine

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Background: Cerebrovascular steno-occlusive disease constitutes one of the most dangerous complications of sickle cell disease (SCD). It could result in overt or silent cerebral infarctions (SCI). Objective: The aim of this study was to demonstrate silent parenchymal and vascular brain changes that are incidentally observed in neurologically free SCD children using screening MRI and MRA. Patients and methods: This prospective cross-sectional study was conducted on 78 children diagnosed with SCD who were neurologically free. Magnetic resonance imaging (MRI) and Magnetic Resonance Angiography (MRA) were done to all the participant children. Results: Thirty (38.4%) of our children demonstrated pathologic parenchymal features on their MRI. There were 29 (37.17%) patients had pathologic changes in MRA; 6 of them had isolated vascular abnormality, whereas the remaining patients had concurrent parenchymal abnormalities. There was significant high positive correlation between low hemoglobin and presence of silent cerebral infarction (SCI). Moya-moya vasculopathy showed significant positive correlation with arterial occlusion and old SCI. HB SS phenotype was significantly correlated with moya-moya vasculopathy, arterial occlusion and old SCI. Conclusions: Silent cerebral and cerebrovascular changes in SCD children are frequent abnormalities requiring utilization of MRI and MRA to find out their exact prevalence and their risk factors.

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Section: Discussionmentioning

confidence: 99%

Silent Brain Changes in Children with Sickle Cell Disease

Hashim¹,

Mokhtar²,

Allam³

2023

The Egyptian Journal of Hospital Medicine

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“…This examination is performed by an experienced neurosonologist, who provides comprehensive and reliable information on the morphological and hemodynamic status of artery diseases. Manual reviewing of ECCD and TCD reports often leads to misclassification, wasteful duplication, and delayed diagnosis [ 24 ]. Machine learning-based CDSS can improve the review process, reduce misclassification, and enhance patient safety and care quality; therefore, machine learning-based CDSS was developed to accurately classify artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Machine Learning Models to Classify Artery Stenosis for Automated Generating Ultrasound Report

et al. 2022

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Duplex ultrasonography (DUS) is a safe, non-invasive, and affordable primary screening tool to identify the vascular risk factors of stroke. The overall process of DUS examination involves a series of complex processes, such as identifying blood vessels, capturing the images of blood vessels, measuring the velocity of blood flow, and then physicians, according to the above information, determining the severity of artery stenosis for generating final ultrasound reports. Generation of transcranial doppler (TCD) and extracranial carotid doppler (ECCD) ultrasound reports involves a lot of manual review processes, which is time-consuming and makes it easy to make errors. Accurate classification of the severity of artery stenosis can provide an early opportunity for decision-making regarding the treatment of artery stenosis. Therefore, machine learning models were developed and validated for classifying artery stenosis severity based on hemodynamic features. This study collected data from all available cases and controlled at one academic teaching hospital in Taiwan between 1 June 2020, and 30 June 2020, from a university teaching hospital and reviewed all patients’ medical records. Supervised machine learning models were developed to classify the severity of artery stenosis. The receiver operating characteristic curve, accuracy, sensitivity, specificity, and positive and negative predictive value were used for model performance evaluation. The performance of the random forest model was better compared to the logistic regression model. For ECCD reports, the accuracy of the random forest model to predict stenosis in various sites was between 0.85 and 1. For TCD reports, the overall accuracy of the random forest model to predict stenosis in various sites was between 0.67 and 0.86. The findings of our study suggest that a machine learning-based model accurately classifies artery stenosis, which indicates that the model has enormous potential to facilitate screening for artery stenosis.

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“…Tuberculous (TB) meningitis is a common type of central nervous system (CNS) infection, especially in developing countries where tuberculosis is endemic 1 . Involvement of cerebral vasculature during TB meningitis may cause multifocal cerebral infarctions, increasing the risk of death or disability 2,3 . Cerebral angiography can identify occlusions or severe stenosis of the main cerebral arteries in patients with TB meningitis; 3 however, it is difficult to use for routine screening due to its invasive nature and cost 2 .…”

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler ultrasonography in tuberculous meningitis: A systematic review

Badillo

Navarro

Qureshi

et al. 2023

Journal of Neuroimaging

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Background and Purpose Tuberculous (TB) meningitis is a common type of central nervous system infection, and may cause multifocal cerebral infarctions due to the involvement of cerebral vasculature. This systematic review aims to review and synthesize the utility of transcranial Doppler (TCD) in TB meningitis. Methods This is a systematic review of observational studies on the use of TCD in patients diagnosed to have TB meningitis. Study outcomes included changes in TCD parameters during stages of TB meningitis, frequency of neurologic complications (such as hydrocephalus, vasculopathy, and cerebral infarction), correlation of TCD findings with neuroimaging, and functional outcomes. Results Five studies were included with a total of 141 participants, with ages from 4 months to 75 years. The most common neurologic complication was hydrocephalus (87.1%), cerebral infarction (29.2%), and arterial stenosis (26.3%). There was increased mean flow velocity (MFV) most commonly in the middle cerebral artery in the early stage of TB meningitis, and decreased MFV in the advanced disease stage. TCD findings of stenosis were well correlated with CT or MR angiogram. Among patients with hydrocephalus, pulsatility indices were significantly decreased after ventriculoperitoneal shunting. Conclusions A considerable proportion of patients with TB meningitis develop cerebral hemodynamic disturbances which lead to cerebral ischemia and affect clinical outcomes. TCD is a reliable tool for the diagnosis of vasculopathy and increased intracranial pressure and can thus help monitor disease progression and treatment response. Future studies with larger populations and longer follow‐ups are recommended to determine the association of TCD findings with functional outcomes.

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Transcranial Doppler Ultrasonography as a Diagnostic Tool for Cerebrovascular Disorders

Cited by 20 publications

References 80 publications

Silent Brain Changes in Children with Sickle Cell Disease

Silent Brain Changes in Children with Sickle Cell Disease

Development and Validation of Machine Learning Models to Classify Artery Stenosis for Automated Generating Ultrasound Report

Transcranial Doppler ultrasonography in tuberculous meningitis: A systematic review

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