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- Title
Derivation of power M-mode transcranial Doppler criteria for angiographic proven MCA occlusion.
- Authors
Saqqur, Maher; Hill, Michael D.; Alexandrov, Andrei V.; Roy, Jayanta; Schebel, Marcia; Krol, Andrea; Garami, Zsolt; Shuaib, Ashfaq; Demchuk, Andrew M.
- Abstract
<bold>Background: </bold>Stringent transcranial Doppler (TCD) criteria for diagnosing occlusion are needed for more reliable TCD performance at bedside in the acute stroke setting. <bold>Subjects and Methods: </bold>At three academic stroke centers, we performed TCD examination for patients with symptoms of cerebral ischemia who underwent digital subtraction angiography (DSA). We used a standard insonation protocol with power M-mode Doppler (PMD) TCD (TCD 100 M, Spencer Technologies Inc., Seattle, WA). We collected mean flow velocity (MFV), pulsatility indices (PI), and power M-mode resistance signature (absent, high, or low) in symptomatic middle (MCA), anterior (ACA), posterior (PCA), and in affected (a), ipsilateral (i), and contralateral (c-lat) cerebral arteries. Ratios of aMCA/c-lat MCA, aMCA/iACA, and aMCA/iPCA MFV were subsequently calculated. PMD-TCD flow findings were evaluated with a receiver-operating characteristic (ROC) analysis for angiographically proven MCA occlusion. <bold>Results: </bold>We studied 120 patients with acute cerebral ischemia with PMD-TCD examinations prior to or immediately after DSA. Lower aMCA velocities pointed to higher probability of occlusion (P= .055). The aMCA/iPCA MFV ratio was superior to the aMCA/iACA ratio and strongly predictive of occlusion at a threshold ratio of 0.5 (RR 2.31 CI(95) 2.13-2.51). High resistance or absent M-mode flow signatures in the proximal MCA were present in 87% of M1 and M2 MCA occlusions (probability 87%). In the presence of a low-resistance PMD signature, obtaining the aMCA/iPCA MFV ratio <0.5 increases probability of occlusion to 87%. Normal MFV ratios and low-resistance M-mode signatures are highly predictive of a negative angiogram for MCA occlusion. <bold>Conclusion: </bold>In acute cerebral ischemia, reliable criteria for proximal MCA occlusion have been developed based on combination of MFV ratios and M-mode flow resistance signatures. Validation of these criteria will require multicenter studies.
- Subjects
TRANSCRANIAL Doppler ultrasonography; CEREBRAL ischemia; CEREBRAL arteries; ARTERIAL occlusions; DIGITAL subtraction angiography; TRANSIENT ischemic attack; PATIENTS
- Publication
Journal of Neuroimaging, 2006, Vol 16, Issue 4, p323
- ISSN
1051-2284
- Publication type
journal article
- DOI
10.1111/j.1552-6569.2006.00055.x