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  • Title: Accuracy of transcranial Doppler compared with CT angiography in diagnosing arterial obstructions in acute ischemic strokes.
    Author: Brunser AM, Lavados PM, Hoppe A, Lopez J, Valenzuela M, Rivas R.
    Journal: Stroke; 2009 Jun; 40(6):2037-41. PubMed ID: 19359640.
    Abstract:
    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.
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