Transcranial Doppler Validation Pilot Study

Abstract

The use of transcranial Doppler sonography (TCD) for the evaluation of patients with ischemic cerebrovascular disease remains controversial. This study was organized to gather preliminary data regarding the sensitivity and specificity of TCD when compared to cerebral angiography in detecting stenosing lesions and collateral flow patterns of the anterior cerebral circulation. Forty-two patients from six medical centers were prospectively enrolled. Each received cerebral angiography and TCD testing within 24 hours of each other. Based on TCD criteria established a priori, the results were first analyzed by a blinded investigator and then by computer. Computerized analyses were then repeated with modified criteria. Collateral flow through the anterior communicating and ophthalmic arteries was detected with sensitivities of 62% and 100%, and specificities of 98% and 92%, respectively. Internal carotid artery proximal and distal severe ( greater than 70%) stenoses were detected with sensitivities of 79% and 100% and specificities of 88% and 97%. Middle and anterior cerebral artery stenoses and middle cerebral artery occlusion were detected with specificities exceeding 98%; however, the data were insufficient to determine sensitivity. Computerized analyses did not permit improvement of sensitivity and specificity of the baseline criteria. The selected TCD criteria are highly specific in detecting intracranial stenoses and collateral flow patterns of the anterior circulation. The criteria have limited but acceptable sensitivity and specificity in detecting internal carotid artery origin severe stenoses, and are highly sensitive in detecting ophthalmic artery retrograde flow. A study with a larger sample is necessary to provide definitive guidelines for diagnosis.

Specific Transcranial Doppler Flow Findings Related to the Presence and Site of Arterial Occlusion

“…Our findings are consistent with those in previous reports describing similar pathophysiological findings [2][3][4][5][6][7][8][9] and provide further data on the frequency of abnormal TCD flow findings with angiographically proved occlusion compared with patent vessels. Specific TCD flow findings are common with proximal arterial occlusion, and these parameters can be applied for emergent evaluation of acute stroke patients and monitoring therapies.…”

“…2,4,6,11 Specific flow parameters were selected on the basis of previous publications indicating their importance for noninvasive vascular diagnosis of arterial occlusion and flow collateralization. [2][3][4][5][6][7][8][9] During TCD examination we documented the following parameters.…”

“…Others reported TCD flow findings with the middle cerebral and posterior circulation arterial occlusions, including absent or diminished flow signals and flow diversion to branching vessels. 5,[7][8][9] However, the data regarding frequency of specific flow findings such as abnormal waveforms, posterior communicating artery (PCoA) flow, compensatory flow increase, or diversion are largely lacking. In our prospective series, TCD had specificity of 94% with sensitivity of 83% to identify the presence of any proximal extracranial or intracranial arterial occlusion compared with angiography.…”

Transcranial Doppler Ultrasound Criteria for Recanalization After Thrombolysis for Middle Cerebral Artery Stroke

“…6 -9 Accuracy parameters for TCD assessment of middle cerebral artery (MCA) occlusion were established previously. 7,8,10 However, the accuracy of TCD in identifying recanalization after thrombolysis remains unknown. The goal of the present study was to compare TCD findings after intravenous thrombolysis with subsequent angiography to determine accuracy parameters for identifying MCA recanalization.…”

Assessment: Transcranial Doppler ultrasonography: [RETIRED]

“…13,14 Stenosis and occlusion of the ICA siphon, proximal (M1) segment of the MCA, intracranial vertebral artery (VA), proximal basilar artery (BA), and proximal (P1) segment of the posterior cerebral artery (PCA) can be reliably detected by TCD. 1,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The relative performance of TCD vs MRA, conventional angiography, or DSA varies by center, characteristics and prevalence of disease in the study population, diagnostic criteria, and technical expertise. Sensitivity, specificity, positive predictive value, and negative predictive value of TCD are generally higher in the anterior circulation than in the vertebrobasilar circulation owing to more variable anatomy and technical difficulties in insonation of the vertebrobasilar circulation.…”