title: Derivation of transcranial Doppler criteria for angiographically proven middle cerebral artery vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Transcranial Doppler (TCD) has been subjected to criticism for detecting vasospasm (VSP). Our study's aim is to derive criteria for middle cerebral artery (MCA) vasospasm (MCA-VSP) based on cerebral angiography (CA).
  
  
  METHODS
  A prospective data of patients with aneurysmal subarachnoid hemorrhage (aSAH) from January 2004 to August 2009. TCD was performed daily from day 2 to 14 from symptom's onset. Follow-up CA was done at day 7-9. TCD mean flow velocities (MFV) of all vessels at baseline (b), middle (m) and before CA (preangio) were recorded. Several MCA MFV ratios were computed. Moderate to severe VSP on CA was defined as >1/3 luminal narrowing. Univariate and stepwise logistic regression analysis were performed.
  
  
  RESULTS
  One hundred sixty-nine patients (338 MCA) with aSAH were included, mean age: 54.8 ± 13, women: 103 (62%). Twenty-nine patients (8.6%) had angiographic MCA-VSP. TCD scoring system of 3 points for MCA-VSP was computed based on (a) bMCA MFV ≥ 120 cm/s (sensitivity: 59.3%, specificity: 85%, PPV: 36.4%, NPV: 93.5%, P < .001) (1 point), Preangio MCA MFV ≥ 150 cm/s (79.3%, 89.9%, 39%, 97.3%, <.001) (1 point), and affected preangio MCA/bMCA MFV ratio ≥ 1.5 (84%, 63%, 25.6%, 96.3%, .001) (1 point). The score of 3 has 96% sensitivity and 96% specificity (OR: 300) whereas the score of 1 has 12% sensitivity and 58% specificity (OR: 4.3) for identifying MCA-VSP.
  
  
  CONCLUSIONS
  TCD stringent criteria for moderate to severe MCA-VSP are feasible and applicable in aSAH population.
authors.affiliation: Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sebastian
authors.forename: Carol
authors.initials: C
authors.lastname: Derksen
authors.forename: Khurshid
authors.initials: K
authors.lastname: Khan
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Bilal
authors.initials: B
authors.lastname: Hameed
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Siddiqui
authors.forename: Michael
authors.initials: M
authors.lastname: Chow
authors.forename: J Max
authors.initials: JM
authors.lastname: Findlay
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Maher
authors.initials: M
authors.lastname: Saqqur
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D015984:Causality; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000706:statistics & numerical data*; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000453:epidemiology*