on March 6, 2008
Published online before print March 6, 2008, doi: 10.1161/STROKEAHA.107.499392
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Submitted on July 17, 2007
From the Comprehensive Stroke Center (G.T., A.A.A., A.V.A.), University of Alabama at Birmingham Hospital, Birmingham, Ala; the Neurosonology and Stroke Research Program (G.T., V.K.S., S.L.H., A.Y.L., M.D.M., A.V.A.), Barrow Neurological Institute, Phoenix, Az; the Department of Neurology (G.T.), University of Athens School of Medicine, Athens, Greece; the Division of Neurology, Department of Medicine (V.K.S.), National University Hospital, Singapore; and the University of Santo Tomas (A.Y.L.), Manila, Philippines. * To whom correspondence should be addressed. E-mail: avalexandrov{at}att.net.
Background and Purpose—Evaluation of posterior circulation with single-gate transcranial Doppler (TCD) is technically challenging and yields lower accuracy parameters in comparison to anterior circulation vessels. Transcranial power motion-mode Doppler (PMD-TCD), in addition to spectral information, simultaneously displays in real-time flow signal intensity and direction over 6 cm of intracranial space. We aimed to evaluate the diagnostic accuracy of PMD-TCD against angiography in detection of acute posterior circulation stenoocclusive disease. Methods—Consecutive patients presenting to the emergency room with symptoms of acute (<24 hours) cerebral ischemia underwent emergent neurovascular evaluation with PMD-TCD and angiography (computed tomographic angiography, magnetic resonance angiography, or digital subtraction angiography). Previously published diagnostic criteria were prospectively applied for PMD-TCD interpretation independent of angiographic findings. Results—A total of 213 patients (119 men; mean age 65±16 years; ischemic stroke 71%, transient ischemic attack 29%) underwent emergent neurovascular assessment. Compared with angiography, PMD-TCD showed 17 true-positive, 8 false-negative, 6 false-positive, and 182 true-negative studies in posterior circulation vessels (sensitivity 73% [55% to 91%], specificity 96% [93% to 99%], positive predictive value 68% [50% to 86%], negative predictive value 95% [92% to 98%], accuracy 93% [90% to 96%]). In 14 patients (82% of true-positive cases), PMD display showed diagnostic flow signatures complementary to the information provided by the spectral display: reverberating or alternating flow, distal basilar artery flow reversal, high-resistance flow, emboli tracks and, bruit flow signatures. Conclusions—PMD-TCD yields a satisfactory agreement with urgent brain angiography in the evaluation of patients with acute posterior circulation cerebral ischemia. PMD display can depict flow signatures that are complimentary to and can increase confidence in standard single-gate TCD spectral findings.
Revised on September 5, 2007
Accepted on September 13, 2007
Applications and Advantages of Power Motion-Mode Doppler in Acute Posterior Circulation Cerebral Ischemia
Georgios Tsivgoulis MD, RVT;
Key words: angiography • ischemia • power motion-mode Doppler • stroke • transcranial Doppler
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