Insonation method and diagnostic flow signatures for transcranial power motion (M-mode) Doppler

Andrei Alexandrov, Andrew M. Demchuk, W. Scott Burgin

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background and purpose. Power motion mode Doppler (PMD) simultaneously displays flow signal intensity and direction over several centimeters of intracranial space. Insonation protocol for PMD and spectral transcranial Doppler (TCD) with typical PMD flow signatures is described in serial patients with acute stroke symptoms examined via conventional windows with a PMD/ TCD unit. Results. Thirty-five patients were studied within 12 hours after stroke onset (age 64 ± 15 years; 8 received intravenous and 3 intra-arterial thrombolysis). One patient had no temporal window, and 3 patients had suboptimal windows. In 90% of patients, PMD showed more than 1 ipsilateral temporal windows. In 63% of patients (n = 22), PMD simultaneously displayed the entire M1 (65-45 mm) and proximal M2 (45-30 mm) flows, leading to spectral TCD examination of the proximal M2 middle cerebral artery (MCA) in 28 of 35 patients (80%). All patients had sufficient foraminal (depth display = 60-110 mm) and orbital (depth display = 30-80 mm) windows. PMD displayed the entire basilar artery stem (75-100+ mm) in 69% (n = 24) of patients, and the distal basilar flow was detected in all patients by both PMD and TCD. TCD results were normal (12), proximal intracranial stenosis (5), large vessel occlusion (17), and cerebral circulatory arrest (1). Compared to spectral TCD, PMD signatures of similar diagnostic significance were low resistance (vessel identification and recanalization), high resistance (ophthalmic artery identification and distal obstruction), collateral (communicating arteries and leptomeningeal flow), reverberating (circulatory arrest), and branch embolization. Conclusions. PMD is a window-finding tool and a guide for spectral TCD gate placement. PMD facilitates flow detection in the M2 branches and the distal basilar artery. PMD can demonstrate recanalization of the entire MCA main stem and proximal branches, increase the yield of embolus detection and procedure monitoring, and facilitate abnormal flow pattern recognition.

Original languageEnglish (US)
Pages (from-to)236-244
Number of pages9
JournalJournal of Neuroimaging
Volume12
Issue number3
DOIs
StatePublished - 2002
Externally publishedYes

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Basilar Artery
Middle Cerebral Artery
Stroke
Ophthalmic Artery
Embolism
Age of Onset
Pathologic Constriction
Arteries
Direction compound

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Neuroscience(all)
  • Radiological and Ultrasound Technology

Cite this

Insonation method and diagnostic flow signatures for transcranial power motion (M-mode) Doppler. / Alexandrov, Andrei; Demchuk, Andrew M.; Burgin, W. Scott.

In: Journal of Neuroimaging, Vol. 12, No. 3, 2002, p. 236-244.

Research output: Contribution to journalArticle

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abstract = "Background and purpose. Power motion mode Doppler (PMD) simultaneously displays flow signal intensity and direction over several centimeters of intracranial space. Insonation protocol for PMD and spectral transcranial Doppler (TCD) with typical PMD flow signatures is described in serial patients with acute stroke symptoms examined via conventional windows with a PMD/ TCD unit. Results. Thirty-five patients were studied within 12 hours after stroke onset (age 64 ± 15 years; 8 received intravenous and 3 intra-arterial thrombolysis). One patient had no temporal window, and 3 patients had suboptimal windows. In 90{\%} of patients, PMD showed more than 1 ipsilateral temporal windows. In 63{\%} of patients (n = 22), PMD simultaneously displayed the entire M1 (65-45 mm) and proximal M2 (45-30 mm) flows, leading to spectral TCD examination of the proximal M2 middle cerebral artery (MCA) in 28 of 35 patients (80{\%}). All patients had sufficient foraminal (depth display = 60-110 mm) and orbital (depth display = 30-80 mm) windows. PMD displayed the entire basilar artery stem (75-100+ mm) in 69{\%} (n = 24) of patients, and the distal basilar flow was detected in all patients by both PMD and TCD. TCD results were normal (12), proximal intracranial stenosis (5), large vessel occlusion (17), and cerebral circulatory arrest (1). Compared to spectral TCD, PMD signatures of similar diagnostic significance were low resistance (vessel identification and recanalization), high resistance (ophthalmic artery identification and distal obstruction), collateral (communicating arteries and leptomeningeal flow), reverberating (circulatory arrest), and branch embolization. Conclusions. PMD is a window-finding tool and a guide for spectral TCD gate placement. PMD facilitates flow detection in the M2 branches and the distal basilar artery. PMD can demonstrate recanalization of the entire MCA main stem and proximal branches, increase the yield of embolus detection and procedure monitoring, and facilitate abnormal flow pattern recognition.",
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