Transcranial Doppler pulsatility index: what it is and what it isn't.
BACKGROUND
Transcranial Doppler (TCD) pulsatility index (PI) has traditionally been interpreted as a descriptor of distal cerebrovascular resistance (CVR). We sought to evaluate the relationship between PI and CVR in situations, where CVR increases (mild hypocapnia) and decreases (plateau waves of intracranial pressure-ICP).


METHODS
Recordings from patients with head-injury undergoing monitoring of arterial blood pressure (ABP), ICP, cerebral perfusion pressure (CPP), and TCD assessed cerebral blood flow velocities (FV) were analyzed. The Gosling pulsatility index (PI) was compared between baseline and ICP plateau waves (n = 20 patients) or short term (30-60 min) hypocapnia (n = 31). In addition, a modeling study was conducted with the "spectral" PI (calculated using fundamental harmonic of FV) resulting in a theoretical formula expressing the dependence of PI on balance of cerebrovascular impedances.


RESULTS
PI increased significantly (p < 0.001) while CVR decreased (p < 0.001) during plateau waves. During hypocapnia PI and CVR increased (p < 0.001). The modeling formula explained more than 65% of the variability of Gosling PI and 90% of the variability of the "spectral" PI (R = 0.81 and R = 0.95, respectively).


CONCLUSIONS
TCD pulsatility index can be easily and quickly assessed but is usually misinterpreted as a descriptor of CVR. The mathematical model presents a complex relationship between PI and multiple haemodynamic variables.
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Box 167, Cambridge, CB2 0QQ, UK.
Nicolás
N
de Riva
Karol P
KP
Budohoski
Peter
P
Smielewski
Magdalena
M
Kasprowicz
Christian
C
Zweifel
Luzius A
LA
Steiner
Matthias
M
Reinhard
Neus
N
Fábregas
John D
JD
Pickard
Marek
M
Czosnyka
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016857:Hypocapnia / Q000000981:diagnostic imaging / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011673:Pulsatile Flow / Q000502:physiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult