Published Online
on July 3, 2003

A more recent version of this article appeared on August 1, 2003

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Submitted on March 15, 2003
Accepted on April 8, 2003

Assessment of Cerebral Blood Flow by Means of Blood-Flow-Volume Measurement in the Internal Carotid Artery. Comparative Study With a ¹³³Xenon Clearance Technique

J. F. Soustiel MD; T. C. Glenn PhD; P. Vespa MD; B. Rinsky; C. Hanuscin; and N. A. Martin MD^*

From the Cerebral Blood Flow Laboratory and Brain Injury Research Center (T.C.G., P.V., B.R., C.H., N.A.M.), Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, and the Department of Neurosurgery (J.F.S.), Rambam Medical Center, Technion, B. Rappaport Faculty of Medicine, Haifa, Israel.

^* To whom correspondence should be addressed. E-mail: neilmartin{at}mednet.ucla.edu.

Background and Purpose--We sought to evaluate a new, angle-independent ultrasonic device for assessment of blood flow volume (BFV) in the internal carotid artery (ICA).

Methods--Nineteen patients and 4 healthy volunteers were enrolled in a comparative study conducted in the Care Unit of the Division of Neurosurgery at UCLA Medical Center. All patients had been admitted because of severe brain injury: 15 patients with severe head trauma (Glasgow Coma Scale score8) and 4 patients with subarachnoid hemorrhage due to aneurysm rupture. In all patients and subjects, cerebral blood flow (CBF) values obtained with the ¹³³xenon-clearance technique were compared with BFV measurements in the ipsilateral ICA.

Results--Hemispheric CBF values showed a close and linear correlation with BFV measurements (r=0.76, P<0.0001). Global CBF values showed a higher correlation with the total BFV value obtained from both ICAs (r=0.84, P<0.0001). With 37 mL · min^-1 · 100 g^-1 as a cutoff value for the ischemic range, a BFV value of 220 mL/min would yield a positive predictive value of 91.7% and a negative predictive value of 82.6% (sensitivity 73.3%, specificity 95%). Conversely, BFV sensitivity and specificity were 60% and 96%, respectively, for the hyperemic range defined by a CBF value >55 mL · min^-1 · 100 g^-1 (positive predictive value of 85.7% and negative prediction value of 85.7%).

Conclusions--BFV measurements with this new technology proved to accurately correlate with CBF values evaluated by the ¹³³xenon-clearance technique. These results support the implementation of this technique for bedside assessment of cerebral hemodynamics in critically ill neurosurgical patients.

Key words: cerebral blood flow • hemodynamics • ultrasonography, Doppler

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