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.
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
Alejandro M
AM
Brunser
Pablo M
PM
Lavados
Arnold
A
Hoppe
Javiera
J
Lopez
Marcela
M
Valenzuela
Rodrigo
R
Rivas
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