Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia

Georgios Tsivgoulis, Vijay K. Sharma, Steven L. Hoover, Annabelle Y. Lao, Agnieszka A. Ardelt, Marc Malkoff, Andrei Alexandrov

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1197-1204
Number of pages8
JournalStroke
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2008

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Brain Ischemia
Angiography
Data Display
Basilar Artery
Digital Subtraction Angiography
Magnetic Resonance Angiography
Transient Ischemic Attack
Embolism
Hospital Emergency Service
Stroke
Power (Psychology)
Brain

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia. / Tsivgoulis, Georgios; Sharma, Vijay K.; Hoover, Steven L.; Lao, Annabelle Y.; Ardelt, Agnieszka A.; Malkoff, Marc; Alexandrov, Andrei.

In: Stroke, Vol. 39, No. 4, 01.04.2008, p. 1197-1204.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Sharma, Vijay K. ; Hoover, Steven L. ; Lao, Annabelle Y. ; Ardelt, Agnieszka A. ; Malkoff, Marc ; Alexandrov, Andrei. / Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia. In: Stroke. 2008 ; Vol. 39, No. 4. pp. 1197-1204.
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abstract = "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.",
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AU - Tsivgoulis, Georgios

AU - Sharma, Vijay K.

AU - Hoover, Steven L.

AU - Lao, Annabelle Y.

AU - Ardelt, Agnieszka A.

AU - Malkoff, Marc

AU - Alexandrov, Andrei

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AB - 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.

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