Improved detection of microbubble signals using power M-mode Doppler.
Background- Power motion-mode transcranial Doppler (TCD) (PMD) is a new, multigated technique that may simplify and enhance detection of embolus. We developed criteria for emboli detection using PMD. Then, we performed a blinded comparison of transcranial PMD with single-gate spectral TCD in TCD bubble study patients.


METHODS
Patients with right-to-left shunt as detected with standard TCD were selected for this study. The international emboli criteria for spectral TCD were used. We defined novel PMD criteria for detecting emboli signature on PMD as follows: (1) signature at least 3 dB higher than the highest spontaneous PMD display of background blood flow; (2) embolic signature reflects motion in one direction at a minimum spatial extent of 7.5 mm and temporal extent of 30 ms; (3) embolus must traverse a prespecified depth. Each study was blindly assessed for microbubble signals (MBS) count on either modality.


RESULTS
Thirty-six patients were included in the study. Mean age was 44.4 (SD 14.4), 50% were male, and median time from stroke onset to TCD bubble test was 12 days. Median MBS count in middle cerebral arteries (MCA) was 4 on both modalities. Spectral TCD MBS counts were highly correlated (rho=0.97) with PMD MBS counts in MCA and similarly in anterior cerebral arteries (ACA) (rho=0.79). When PMD microbubble counts in the ACA and MCA were summed, a clear 2-fold difference emerged between 2 modalities (P<0.001).


CONCLUSIONS
When compared with spectral TCD, PMD detects more MBS with higher counts by identifying ACA as well as MCA emboli. Pitfalls of overcounting emboli with PMD can be avoided by following such criteria.
Saqqur
Maher
M
Department of Medicine (Neurology), University of Calgary, Calgary, Alberta, Canada.
Dean
Naeem
N
Schebel
Marcia
M
Hill
Michael D
MD
Salam
Abdul
A
Shuaib
Ashfaq
A
Demchuk
Andrew M
AM
D000328:Adult; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation / Q000379:methods*; D014636:Valsalva Maneuver