title: A combined power m-mode and single gate transcranial doppler ultrasound microemboli signal criteria for improving emboli detection and reliability.
abstract: OBJECTIVE
  Single gate transcranial Doppler spectrogram (sgTCD) has a high variability in the detection of microembolic signals (MES), Adding Power M-mode Doppler (PMD) information may improve MES detection. Our study's aim is to derive combined PMD/sgTCD microemboli criteria to overcome this limitation.
  
  
  METHODS
  Patients with symptomatic carotid disease were prospectively enrolled within 24 h of symptom onset underwent 1 hour TCD emboli monitoring. We reviewed disparity between PMD MES criteria and sgTCD MES criteria. We compared combined PMD/sgTCD criteria to sgTCD alone criteria by measuring the intraclass correlation coefficient (ICC).
  
  
  RESULTS
  Of 92 patients, 28 patients had evidence of MES on sgTCD or PMD. Total MES count was 269 based on sgTCD criteria, and 326 based on combined PMD/sgTCD criteria (P= 0.005). Combined PMD/sgTCD criteria revealed 17 MESs (4.8%) based on sgTCD criteria to represent artifacts and 57 MESs (17.5%) not to be detected by sgTCD criteria. Overall ICC based on sgTCD criteria was 0.67 [95% confidence interval (CI): 0.58-0.74]; however, introducing combined PMD/sgTCD criteria resulted in a significant increase in the ICC, 0.91 (95% CI: 0.88-0.93).
  
  
  CONCLUSIONS
  Our combined PMD/sgTCD criteria for MES appeared to improve the yield of MES detection. Reliability in MES detection interpretation was improved when combined PMD/sgTCD criteria was applied.
authors.affiliation: Department of Neurology, Catholic University of Korea, Seoul, South Korea.
authors.forename: Youngbin
authors.initials: Y
authors.lastname: Choi
authors.forename: Maher
authors.initials: M
authors.lastname: Saqqur
authors.forename: Talip
authors.initials: T
authors.lastname: Asil
authors.forename: Albert
authors.initials: A
authors.lastname: Jin
authors.forename: Eileen
authors.initials: E
authors.lastname: Stewart
authors.forename: Caroline
authors.initials: C
authors.lastname: Stephenson
authors.forename: Mohamad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Jayanta
authors.initials: J
authors.lastname: Roy
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Boulanger
authors.forename: Shelagh
authors.initials: S
authors.lastname: Coutts
authors.forename: Firosh
authors.initials: F
authors.lastname: Khan
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
mesh_terms: D000368:Aged; D000465:Algorithms; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging*; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*