Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Is Transcranial Doppler Ultrasonography Old-fashioned?: One Institutional Validity Study

  • Han, Pan-Yeal (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital) ;
  • Kim, Jae-Hoon (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital) ;
  • Kang, Hee-In (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital) ;
  • Moon, Byung-Gwan (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital) ;
  • Lee, Seung-Jin (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital) ;
  • Kim, Joo-Seung (Department of Neurosurgery, School of Medicine, Eulji University, Nowon Eulji Hospital)
  • Published : 2008.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purpose of this study is to investigate the correlation between various transcranial Doppler (TCD) ultrasonography parameters and clinical vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods : This study enrolled 40 patients presented with aneurysmal SAH between September 2006 and August 2007. We measured differences of mean blood flow velocity (BFVm), highest systolic blood flow velocity (BFVh), and Lindegaard ratio (LR) in the middle cerebral artery on TCD examination. These parameters were evaluated for correlation with clinical vasospasm by univariate analysis and the receiver operating characteristic analysis. Results : Twelve patients (30%) developed clinical vasospasm. The best TCD parameters for the detection of clinical vasospasm were revealed to be differences of BFVm, BFVh, and LR values between $1^{st}$ TCD test and $3^{rd}$ TCD (7 cm/s. 11.5 cm/s, 0.45 respectively). The positive predictive value of anyone of three parameters was 60% and the negative predictive value was 100%. Conclusion : TCD is still considered a useful tool for screening clinical vasospasm. To confirm the predictive value of the above parameters. further prospective study will be needed.

Keywords

References

  1. Aaslid R : Transcranial Doppler assessment of cerebral vasospasm. Eur J Ultrasound 16 : 3-10, 2002
  2. Aaslid R, Huber P, Nornes H : Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60 : 37-41, 1984 https://doi.org/10.3171/jns.1984.60.1.0037
  3. Griner PF, Mayewski RJ, Mushlin AI, Greenland P : Selection and interpretation of diagnostic tests and procedures : principles and applications. Ann Intern Med 94 : 553-600, 1981
  4. Hanley JA, McNeil BJ : A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148 : 839-843, 1983 https://doi.org/10.1148/radiology.148.3.6878708
  5. Hanley JA, McNeil BJ : The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143 : 29-36, 1982 https://doi.org/10.1148/radiology.143.1.7063747
  6. Jabre A, Babikian V, Powsner RA, Spatz EL : Role of single photon emission computed tomography and transcranial Doppler ultrasonography in clinical vasospasm. J Clin Neurosci 9 : 400-403, 2002 https://doi.org/10.1054/jocn.2002.1007
  7. Kim JM, Kang SD : Reliability of transcranial Doppler examination in the diagnosis of delayed ischemia after subarachnoid hemorrhage. J Korean Neurosurg Soc 37 : 253-257, 2005
  8. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P : Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 100 : 12-24, 1989 https://doi.org/10.1007/BF01405268
  9. Lysakowski C, Walder B, Costanza MC, Tramer MR : Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm : a systemic review. Stroke 32 : 2292-2298, 2001 https://doi.org/10.1161/hs1001.097108
  10. Manno EM, Gress DR, Schwamm LH, Diringer MN, Ogilvy CS : Effects of induced hypertension on transcranial Doppler ultrasound velocities in patients after subarachnoid hemorrhage. Stroke 29 : 422-428, 1998 https://doi.org/10.1161/01.STR.29.2.422
  11. Mariak Z, Krejza J, Swiercz M, Kordecki K, Lewko J : Accuracy of transcranial color Doppler ultrasonography in the diagnosis of middle cerebral artery spasm determined by receiver operating characteristics analysis. J Neurosurg 96 : 323-330, 2002 https://doi.org/10.3171/jns.2002.96.2.0323
  12. Mascia L, Fedorko L, terBrugge K, Filippini C, Pizzio M, Ranieri VM, et al : The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med 29 : 1088-1094, 2003 https://doi.org/10.1007/s00134-003-1780-5
  13. McGirt MJ, Blessing RP, Goldstein LB : Transcranial Doppler monitoring and clinical decision-making after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 12 : 88-92, 2003 https://doi.org/10.1053/jscd.2003.10
  14. Minhas PS, Menon DK, Smielewski P, Cznosnyka M, Kirkpatrick PJ, Clark JC et al : Positron emission tomographic cerebral perfusion disturbances and transcranial doppler findings among patients with neurological deterioration after subarachnoid hemorrhage. Neurosurgery 52 : 1017-1024, 2003 https://doi.org/10.1227/01.NEU.0000058231.08870.1F
  15. Mizuno M, Nakajima S, Sampei T, Nishimura H, Hadeishi H, Suzuki A, et al : Serial transcranial Doppler flow velocity and cerebral blood flow measurements for evaluation of cerebral vasospasm after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 34 : 164-171, 1994 https://doi.org/10.2176/nmc.34.164
  16. Naval NS, Thomas CE, Urrutia VC : Relative changes in flow velocities in vasospasm after subarachnoid hemorrhage: a transcranial Doppler study. Neurocrit Care 2 : 133-140, 2005 https://doi.org/10.1385/NCC:2:2:133
  17. Proust F, Callonec F, Clavier E, Lestrat JP, Hannequin D, Thiebot J, et al : Usefulness of transcranial color-coded sonography in the diagnosis of cerebral spasm. Stroke 30 : 1091-1098, 1999 https://doi.org/10.1161/01.STR.30.5.1091
  18. Rudolf L, Ralf S, Friedrich G, Thomas V, Ralf P, Rudolf F : Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography. part 1. reliability of flow velocities in clinical management. Neurosurgery 33 : 1-9, 1993 https://doi.org/10.1227/00006123-199307000-00001
  19. Suarez JI, Qureshi AI, Yahia AB, Parekh PD, Tamargo RJ, Williams MA, et al : Symptomatic vasospasm diagnosis after subarachnoid hemorrhage : evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med 30 : 1348-1355, 2002 https://doi.org/10.1097/00003246-200206000-00035
  20. Torbey MT, Hauser TK, Bhardwaj A, Williams MA, Ulatowski JA, Mirski MA, et al : Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 32 : 2005-2011, 2001 https://doi.org/10.1161/hs0901.094622
  21. Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM : Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 44 : 1237-1248, 1999 https://doi.org/10.1097/00006123-199906000-00039
  22. Zweig MH, Campbell G : Receiver-operating characteristic (ROC) plots : a fundamental evaluation tool in clinical medicine. Clin Chem 39 : 561-577, 1993