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(Stroke. 2001;32:1291.)
© 2001 American Heart Association, Inc.

Original Contributions

Power Transcranial Doppler Ultrasound in the Detection of Intracranial Aneurysms

Philip M. White, FRCR; Joanna M. Wardlaw, FRCR; Evelyn Teasdale, FRCR; Stuart Sloss, DCR; Jim Cannon, DCR Valerie Easton, BSc

From the Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow (P.M.W., E.T., S.S.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh (P.M.W., J.M.W., J.C., V.E.); and Department of Community Health Sciences, University of Edinburgh (V.E.) (UK).

Correspondence to Dr P.M. White, Department of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Bldg, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK. E-mail pmw{at}skull.dcn.ed.ac.uk

Background and Purpose—We sought to perform a large, prospective, multicenter, blinded study comparing power transcranial color duplex sonography (power TCDS) with intra-arterial digital subtraction angiography (IADSA) in the detection of intracranial aneurysms.

Methods—Contemporaneous TCDS and IADSA examinations were performed in 171 subjects with suspected intracranial aneurysm. Via the temporal bone window, a 2-dimensional hand-held noncontrast transcranial duplex ultrasound imaging system was used operating in power and spectral modes. Sonographers were blinded to clinical history and results of brain CT and IADSA.

Results—We found that 157 subjects (92%) had an adequate bone window. Sensitivity per patient was 0.78 (95% CI, 0.66 to 0.87) and 0.46 (95% CI, 0.36 to 0.56) for any anterior circulation aneurysms. Sensitivity was 0.35 (95% CI, 0.24 to 0.46) for aneurysms 5 mm and 0.81 (95% CI, 0.62 to 0.94) for aneurysms >5 mm. Accuracy was lower for aneurysms on the cavernous and terminal internal carotid arteries, including posterior communicating artery origin (0.71; 95% CI, 0.63 to 0.79), than for those on the anterior (0.82; 95% CI, 0.74 to 0.89) or the middle cerebral arteries (0.79; 95% CI, 0.71 to 0.86).

Conclusions—Power TCDS is a promising, inexpensive, noninvasive test for anterior circulation intracranial aneurysms but is less sensitive per aneurysm than alternatives such as CT angiography or MR angiography. Sensitivity is poor for aneurysms 5 mm in diameter. The internal carotid artery is the most difficult segment to interpret.

Key Words: cerebral aneurysm • cerebral angiography • ultrasonography, Doppler, transcranial

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