Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
OBJECTIVE
To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis.


METHODS
The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations.


RESULTS
TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.
Sloan
M A
MA
Rush University Medical Center, Chicago, IL, USA.
Alexandrov
A V
AV
Tegeler
C H
CH
Spencer
M P
MP
Caplan
L R
LR
Feldmann
E
E
Wechsler
L R
LR
Newell
D W
DW
Gomez
C R
CR
Babikian
V L
VL
Lefkowitz
D
D
Goldman
R S
RS
Armon
C
C
Hsu
C Y
CY
Goodin
D S
DS
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging; D008297:Male; D008991:Monitoring, Physiologic; D009462:Neurology / Q000458:organization & administration; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D013673:Technology Assessment, Biomedical / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy; D017585:Ultrasonography, Doppler, Transcranial / Q000592:standards / Q000706:statistics & numerical data*