Published Online
on July 14, 2005

A more recent version of this article appeared on August 1, 2005

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Submitted on March 9, 2005
Revised on April 15, 2005
Accepted on May 24, 2005

Can Transcranial Doppler Discriminate Between Solid and Gaseous Microemboli? Assessment of a Dual-Frequency Transducer System

Hugh S. Markus FRCP^* and Martin Punter MRCP

From Clinical Neuroscience, Department of Cardiac and Vascular Sciences, St George’s Hospital Medical School, London, UK.

^* To whom correspondence should be addressed. E-mail: hmarkus{at}sghms.ac.uk.

Background and Purpose--Transcranial Doppler ultrasound can reliably detect both gaseous and solid cerebral emboli. However, conventional equipment is unable to discriminate between gaseous and solid emboli. This is a major limitation in situations in which the 2 coexist, because they may have very different clinical relevance. Recently, a novel Embo-Dop system, using insonation at 2 ultrasound transducer frequencies, has been developed. An initial study with a small sample size suggested it provided excellent discrimination. We performed a validation study in subjects with embolic signals of known nature.

Methods--Gaseous embolic signals were obtained in 7 patients with known patient foramen ovale by intravenous injection of agitated saline injections. Solid embolic signals were obtained in patients with symptomatic carotid stenosis (N=23). Discrimination of the 2 using the Embo-Dop system dual-frequency system was assessed. It was compared with discrimination using embolic signal maximum intensity with an intensity threshold.

Results--One hundred forty-five solid embolic signals were recorded from carotid stenosis patients. Seventy-three were classified as solid and 72 as gaseous by the Embo-Dop system. Six hundred forty-eight gaseous embolic signals were recorded from 7 patients with patent foramen ovale. Six hundred twenty-five were classified as gaseous and 23 as solid. This gave a sensitivity of 50.3% and specificity of 96.5% for detecting solid embolic signals. Discrimination was better than using a simple intensity threshold.

Conclusions--The Embo-Dop dual-frequency system allows better discrimination than a simple intensity threshold but it is not accurate enough for use in clinical or research studies. Further work is needed to develop reliable clinical systems for discrimination of emboli.

Key words: cerebral circulation • embolism • ultrasonography, Doppler, transcranial

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