Περίληψη:
Background and Purpose-Both transcranial Doppler (TCD) and spiral
computed tomography angiography (CTA) are used for noninvasive vascular
assessment tools in acute stroke. We aimed to evaluate the diagnostic
accuracy of TCD against CTA in patients with acute cerebral ischemia.
Methods-Consecutive patients presenting to the Emergency Department with
symptoms of acute (< 24 hours) cerebral ischemia underwent emergent
high-resolution brain CTA with a multidetector helical scanner. TCD was
performed at bedside with a standardized, fast-track insonation protocol
before or shortly (< 2 hours) after completion of the CTA. Previously
published diagnostic criteria were prospectively applied for TCD
interpretation independent of angiographic findings.
Results-A total of 132 patients (74 men, mean +/- SD age 63 +/- 15
years) underwent emergent neurovascular assessment with brain CTA and
TCD. Compared with CTA, TCD showed 34 true-positive, 9 false-negative, 5
false-positive, and 84 true-negative studies (sensitivity 79.1%,
specificity 94.3%, positive predictive value 87.2%, negative
predictive value 90.3%, and accuracy 89.4%). In 9 cases (7%), TCD
showed findings complementary to the CTA (real-time embolization,
collateralization of flow with extracranial internal carotid artery
disease, alternating flow signals indicative of steal phenomenon).
Conclusions-Bedside TCD examination yields satisfactory agreement with
urgent brain CTA in the evaluation of patients with acute cerebral
ischemia. TCD can provide real-time flow findings that are complementary
to information provided by CTA.
Συγγραφείς:
Tsivgoulis, Georgios
Sharma, Vijay K.
Lao, Annabelle Y. and
Malkoff, Marc D.
Alexandrov, Andrei V.
