Sensitivity and specificity of transcranial Doppler ultrasonography in the detection of high-grade carotid stenosis.
We evaluated the ability of transcranial Doppler ultrasonography (TCD) of the middle cerebral artery to detect internal carotid artery luminal area stenosis of 70% or greater by comparing TCD with cerebral angiography in 79 subjects, including 22 with normal cerebral arteriograms and 57 with 30% to 100% internal carotid artery stenosis on at least one side. Of six TCD measurements assessed, the flow acceleration provided the greatest sensitivity (82%) and specificity (73%) in distinguishing 70% to 100% carotid stenosis from lesser degrees of stenosis. The overall accuracy of the flow acceleration was 78%, and the positive predictive value was 79%. A flow acceleration of 351.6 cm/sec2 or less was useful for detecting high-grade stenosis, but there was difficulty in distinguishing unilateral from bilateral high-grade stenosis. TCD measurement of the flow acceleration allows for fairly reliable detection of high-grade stenosis and can thus serve as a useful indirect component of a carotid noninvasive battery.
Kelley
R E
RE
Department of Neurology, University of Miami School of Medicine, FL.
Namon
R A
RA
Mantelle
L L
LL
Chang
J Y
JY
D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial