Accuracy of transcranial Doppler compared with CT angiography in diagnosing arterial obstructions in acute ischemic strokes.
OBJECTIVE
Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of <24 hours.


METHODS
Consecutive patients presenting with acute ischemic stroke to the emergency department underwent high-resolution brain CT angiography and PMD-TCD within a 6-hour difference.


RESULTS
A total of 100 patients were included. PMD-TCD demonstrated 34 intracranial occlusions and CTA 33. There were 6 false-positives and 4 false-negative diagnoses with PMD-TCD. PMD-TCD had a positive likelihood ratio of 13.7, a negative likelihood ratio of 0.19, sensitivity of 81.8%, and specificity of 94% for detecting an arterial occlusion in any specific artery. Results for the middle cerebral artery were: positive likelihood ratio 24.6, negative likelihood ratio 0.045, sensitivity 95.6%, and specificity 96.2%. For the anterior circulation, the results were: positive likelihood ratio 18.5, negative likelihood ratio 0, sensitivity 100%, and specificity 94.5%. For the posterior circulation, the results were: positive likelihood ratio >1000, negative likelihood ratio 0.42, sensitivity 57.1%, and specificity 100%. The post-test probability for any occluded artery when PMD-TCD was positive increased for any admission National Institutes of Health Stroke Scale score but was especially remarkable for National Institutes of Health Stroke Scale scores between 7 and 15 points.


CONCLUSIONS
PMD-TCD is valid compared with CT angiography for the diagnosis of arterial occlusions in patients with acute ischemic stroke, especially in middle cerebral artery obstructions.
Brunser
Alejandro M
AM
Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo Santiago Chile, Av Manquehue Norte 1410, Vitacura 7630000, Santiago, Chile. abrunser@alemana.cl
Lavados
Pablo M
PM
Hoppe
Arnold
A
Lopez
Javiera
J
Valenzuela
Marcela
M
Rivas
Rodrigo
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial