Practice standards for transcranial Doppler (TCD) ultrasound. Part II. Clinical indications and expected outcomes.
BACKGROUND
Transcranial Doppler (TCD) is a physiological ultrasound test with established safety and efficacy. Although imaging devices may be used to depict intracranial flow superimposed on structural visualization, the end-result provided by imaging duplex or nonimaging TCD is sampling physiological flow variables through the spectral waveform assessment.


RESULTS
Clinical indications considered by this multidisciplinary panel of experts as established are: sickle cell disease, cerebral ischemia, detection of right-to-left shunts (RLS), subarachnoid hemorrhage, brain death, and periprocedural or surgical monitoring. The following TCD-procedures are performed in routine in- and outpatient clinical practice: complete or partial TCD-examination to detect normal, stenosed, or occluded intracranial vessels, collaterals to locate an arterial obstruction and refine carotid-duplex or noninvasive angiographic findings; vasomotor reactivity testing to identify high-risk patients for first-ever or recurrent stroke; emboli detection to detect, localize, and quantify cerebral embolization in real time; RLS-detection in patients with suspected paradoxical embolism or those considered for shunt closure; monitoring of thrombolysis to facilitate recanalization and detect reocclusion; monitoring of endovascular stenting, carotid endarterectomy, and cardiac surgery to detect perioperative embolism, thrombosis, hypo- and hyperperfusion.


CONCLUSIONS
By defining the scope of practice, these standards will assist referring and reporting physicians and third parties involved in the process of requesting, evaluating, and acting upon TCD results.
Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35249-3280, USA. avalexandrov@att.net
Andrei V
AV
Alexandrov
Michael A
MA
Sloan
Charles H
CH
Tegeler
David N
DN
Newell
Alan
A
Lumsden
Zsolt
Z
Garami
Christopher R
CR
Levy
Lawrence K S
LK
Wong
Colleen
C
Douville
Manfred
M
Kaps
Georgios
G
Tsivgoulis
D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D006801:Humans; D011871:Radiology / Q000592:standards*; D017585:Ultrasonography, Doppler, Transcranial / Q000592:standards*; D014481:United States