Power transcranial Doppler ultrasound in the detection of intracranial aneurysms.
OBJECTIVE
We sought to perform a large, prospective, multicenter, blinded study comparing power transcranial color duplex sonography (power TCDS) with intra-arterial digital subtraction angiography (IADSA) in the detection of intracranial aneurysms.


METHODS
Contemporaneous TCDS and IADSA examinations were performed in 171 subjects with suspected intracranial aneurysm. Via the temporal bone window, a 2-dimensional hand-held noncontrast transcranial duplex ultrasound imaging system was used operating in power and spectral modes. Sonographers were blinded to clinical history and results of brain CT and IADSA.


RESULTS
We found that 157 subjects (92%) had an adequate bone window. Sensitivity per patient was 0.78 (95% CI, 0.66 to 0.87) and 0.46 (95% CI, 0.36 to 0.56) for any anterior circulation aneurysms. Sensitivity was 0.35 (95% CI, 0.24 to 0.46) for aneurysms </=5 mm and 0.81 (95% CI, 0.62 to 0.94) for aneurysms >5 mm. Accuracy was lower for aneurysms on the cavernous and terminal internal carotid arteries, including posterior communicating artery origin (0.71; 95% CI, 0.63 to 0.79), than for those on the anterior (0.82; 95% CI, 0.74 to 0.89) or the middle cerebral arteries (0.79; 95% CI, 0.71 to 0.86).


CONCLUSIONS
Power TCDS is a promising, inexpensive, noninvasive test for anterior circulation intracranial aneurysms but is less sensitive per aneurysm than alternatives such as CT angiography or MR angiography. Sensitivity is poor for aneurysms </=5 mm in diameter. The internal carotid artery is the most difficult segment to interpret.
White
P M
PM
Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK. pmw@skull.dcn.ed.ac.uk
Wardlaw
J M
JM
Teasdale
E
E
Sloss
S
S
Cannon
J
J
Easton
V
V
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply / Q000473:pathology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation / Q000379:methods