This Article Full Text Full Text (PDF) All Versions of this Article: 40/6/2037    most recent STROKEAHA.108.542704v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brunser, A. M. Articles by Rivas, R. Search for Related Content PubMed PubMed Citation Articles by Brunser, A. M. Articles by Rivas, R. Related Collections Acute Cerebral Infarction Doppler ultrasound, Transcranial Doppler etc.

(Stroke. 2009;40:2037.)
© 2009 American Heart Association, Inc.

Original Contributions

Accuracy of Transcranial Doppler Compared With CT Angiography in Diagnosing Arterial Obstructions in Acute Ischemic Strokes

Alejandro M. Brunser, MD; Pablo M. Lavados, MD; Arnold Hoppe, MD; Javiera Lopez, MD; Marcela Valenzuela, MD Rodrigo Rivas, MD

From the Cerebrovascular Program, Neurology Service, Department of Medicine (A.M.B., P.M.L., A.H.), Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana–Universidad del Desarrollo, Santiago, Chile; Facultad de Medicina and the Neurocritical Care Unit, Institute of Neurosurgery, Department of Neurological Sciences (P.M.L.), Universidad del Desarrollo, Santiago, Chile; the Stroke Unit (J.L.), Servicio de Neurología, Dr Sótero del Rio Hospital and Cerebrovascular Program, Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; the Stroke Unit (M.V.), Unidad de Neurología, Servicio de Medicina, Padre Hurtado Hospital and Cerebrovascular Program, Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and the Cerebrovascular Program (R.R.), Servicio de Neurología, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.

Correspondence to Alejandro M. Brunser, MD, Director, Neurosonology Laboratory, Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana–Universidad del Desarrollo Santiago Chile, Av Manquehue Norte 1410, 10th floor, Vitacura 7630000, Santiago, Chile. E-mail abrunser{at}alemana.cl, abrunser2002@yahoo.com

Background and Purpose— Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of <24 hours.

Methods— Consecutive patients presenting with acute ischemic stroke to the emergency department underwent high-resolution brain CT angiography and PMD-TCD within a 6-hour difference.

Results— A total of 100 patients were included. PMD-TCD demonstrated 34 intracranial occlusions and CTA 33. There were 6 false-positives and 4 false-negative diagnoses with PMD-TCD. PMD-TCD had a positive likelihood ratio of 13.7, a negative likelihood ratio of 0.19, sensitivity of 81.8%, and specificity of 94% for detecting an arterial occlusion in any specific artery. Results for the middle cerebral artery were: positive likelihood ratio 24.6, negative likelihood ratio 0.045, sensitivity 95.6%, and specificity 96.2%. For the anterior circulation, the results were: positive likelihood ratio 18.5, negative likelihood ratio 0, sensitivity 100%, and specificity 94.5%. For the posterior circulation, the results were: positive likelihood ratio >1000, negative likelihood ratio 0.42, sensitivity 57.1%, and specificity 100%. The post-test probability for any occluded artery when PMD-TCD was positive increased for any admission National Institutes of Health Stroke Scale score but was especially remarkable for National Institutes of Health Stroke Scale scores between 7 and 15 points.

Conclusions— PMD-TCD is valid compared with CT angiography for the diagnosis of arterial occlusions in patients with acute ischemic stroke, especially in middle cerebral artery obstructions.

Key Words: Doppler ultrasound • intracranial arterial diseases • sensitivity • specificity • stroke • ultrasonography