Stroke, Vol 25, 2187-2197, Copyright © 1994 by American Heart Association
MA Sloan, CM Burch, MA Wozniak, MI Rothman, D Rigamonti, T Permutt and Y Numaguchi
BACKGROUND AND PURPOSE: Transcranial Doppler sonography is of established
value in the detection and monitoring of middle cerebral artery vasospasm.
Little information exists on the utility of transcranial Doppler for
detection of posterior circulation vasospasm. METHODS: Cerebral angiography
and conventional hand-held transcranial Doppler sonography were compared to
determine sensitivity and specificity of transcranial Doppler for detection
of vertebral and basilar artery vasospasm. RESULTS: Of 59 consecutive
subarachnoid hemorrhage patients with transcranial Doppler angiogram
correlations, 42 underwent posterior circulation angiography to evaluate 64
vertebral arteries and 42 basilar arteries during the period of risk for
vasospasm and had technically adequate transcranial Doppler examinations
within 24 hours of the angiogram. A mean flow velocity of 60 cm/s and above
was indicative of both vertebral and basilar artery vasospasm. For the
vertebral artery, there were 7 true-positive test results, 42
true-negatives, 6 false-positives (unknown cause in 3, increased collateral
flow in 1, adjacent vessel vasospasm in 1, hyperperfusion in 1), and 9
false-negatives (anatomic in 7, operator error in 2). Sensitivity was 44%
and specificity was 87.5%. For the basilar artery, there were 10
true-positives, 23 true-negatives, 6 false-positives (unknown cause in 4,
hyperemia/hyperperfusion in 1, increased collateral flow in 1), and 3
false-negatives (operator error in 2, tortuous vessel course in 1).
Sensitivity was 76.9% and specificity was 79.3%. When the diagnostic
criterion was changed to > or = 80 cm/s (vertebral artery) and > or =
95 cm/s (basilar artery), all false-positive results were eliminated
(specificity and positive predictive value, 100%). CONCLUSIONS: Our data
suggest that transcranial Doppler has good specificity for the detection of
vertebral artery vasospasm and good sensitivity and specificity for the
detection of basilar artery vasospasm. Transcranial Doppler is highly
specific (100%) for vertebral and basilar artery vasospasm when flow
velocities are > or = 80 and > or = 95 cm/s, respectively.
ARTICLES
Transcranial Doppler detection of vertebrobasilar vasospasm following subarachnoid hemorrhage
Department of Neurology, University of Maryland School of Medicine, Baltimore.
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