Περίληψη:
Background and Purpose - Evaluation of posterior circulation with
single-gate transcranial Doppler (TCD) is technically challenging and
yields lower accuracy parameters in comparison to anterior circulation
vessels. Transcranial power motion-mode Doppler (PMD-TCD), in addition
to spectral information, simultaneously displays in real-time flow
signal intensity and direction over 6 cm of intracranial space. We aimed
to evaluate the diagnostic accuracy of PMD-TCD against angiography in
detection of acute posterior circulation stenoocclusive disease.
Methods - Consecutive patients presenting to the emergency room with
symptoms of acute (< 24 hours) cerebral ischemia underwent emergent
neurovascular evaluation with PMD-TCD and angiography (computed
tomographic angiography, magnetic resonance angiography, or digital
subtraction angiography). Previously published diagnostic criteria were
prospectively applied for PMD-TCD interpretation independent of
angiographic findings.
Results - A total of 213 patients (119 men; mean age 65 +/- 16 years;
ischemic stroke 71%, transient ischemic attack 29%) underwent emergent
neurovascular assessment. Compared with angiography, PMD-TCD showed 17
true-positive, 8 false-negative, 6 false-positive, and 182 true-negative
studies in posterior circulation vessels (sensitivity 73% [55% to
91%], specificity 96% [93% to 99%], positive predictive value 68%
[50% to 86%], negative predictive value 95% [92% to 98%],
accuracy 93% [90% to 96%]). In 14 patients (82% of true-positive
cases), PMD display showed diagnostic flow signatures complementary to
the information provided by the spectral display: reverberating or
alternating flow, distal basilar artery flow reversal, high-resistance
flow, emboli tracks and, bruit flow signatures.
Conclusions - PMD-TCD yields a satisfactory agreement with urgent brain
angiography in the evaluation of patients with acute posterior
circulation cerebral ischemia. PMD display can depict flow signatures
that are complimentary to and can increase confidence in standard
single-gate TCD spectral findings.
Συγγραφείς:
Tsivgoulis, Georgios
Sharma, Vijay K.
Hoover, Steven L.
Lao,
Annabelle Y.
Ardelt, Agnieszka A.
Malkoff, Marc D. and
Alexandrov, Andrei V.
