Role of Transcranial Doppler Monitoring in the Diagnosis of Cerebral Vasospasm after Subarachnoid Hemorrhage

Role of Transcranial Doppler Monitoring in the Diagnosis of Cerebral Vasospasm after Subarachnoid... AbstractOBJECTIVEThe purpose of this study was to determine the correlation between transcranial Doppler (TCD) velocities and angiographic vasospasm after aneurysmal subarachnoid hemorrhage.METHODSIn the first part of this study, patients were retrospectively reviewed to correlate middle cerebral artery absolute blood flow velocities with angiographic vasospasm. In the second part of the study, the middle cerebral artery/ipsilateral extracranial internal carotid artery velocity ratio (Lindegaard ratio) was prospectively correlated with angiographic vasospasm. Angiographic vasospasm was independently graded, by observers blinded to the TCD results, as either none, mild (less than one-third artery luminal narrowing), moderate (one-third to one-half narrowing), or severe (more than one-half narrowing). The sensitivity, specificity, likelihood ratios for positive and negative TCD results, positive and negative predictive values, and k and P values were calculated.RESULTSOne hundred one patients were analyzed in the first part of the study, and 44 patients were analyzed in the second part. Interobserver agreement regarding angiographic vasospasm was good (k = 0.86). Despite significant correlation between mean velocities and the degree of vasospasm, the clinical dependability of TCD velocities (evaluated using predictive values and likelihood ratios) was limited. The positive predictive value of velocities of ≥200 cm/s for moderate/severe angiographic vasospasm was 87% but that of lower velocities was approximately 50%. the negative predictive value of velocities of <120 cm/s was 94% but that of higher velocities was approxiametly 75%. only the likelihood ratio for velocity of <120 or ≥200 cm/s were useful (likelihood ratio for negative result=0.17), likehood ratio for positive result=16.39). overall, 57% of patients exhibited maximum velocities in the indeterminate range between 120 and 199 cm/s. Lindegaard ratios did not improve the predictive value of TCD monitoring.CONCLUSIONFor individual patients, only low or very high middle cerebral artery flow velocities (i.e., <120 or ≥200 cm/s) reliably predicted the absence or presence of clinically significant angiographic vasospasm. Intermediate velocities, which were observed for approximately one-half of the patients, were not dependable and should be interpreted with caution http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Role of Transcranial Doppler Monitoring in the Diagnosis of Cerebral Vasospasm after Subarachnoid Hemorrhage

Role of Transcranial Doppler Monitoring in the Diagnosis of Cerebral Vasospasm after Subarachnoid Hemorrhage

Role of Transcranial Doppler Monitoring in the Diagnosis of Cerebral Vasospasm after Subarachnoid Hemorrhage Yashail Y. Vora, M .D., Maria Suarez-Almazor, M .D., Ph.D., David E. Steinke, M .D., Michael L. Martin, M .D ., J. Max Findlay, M .D., Ph.D. D ivisio n of Neurosurgery (Y Y V , DES, JMF) and Departments of Public Health (MS-A) and Radiology (M LM ), University of Alberta Hospital, Alberta, Canada OBJECTIVE: T h e p u r p o s e o f t h is s t u d y w a s to d e t e r m i n e th e c o r r e l a t i o n b e t w e e n t r a n s c r a n i a l D o p p l e r ( T C D ) velocities a n d a n g i o g r a p h i c v a s o s p a s m a f t e r a n e u r y s m a l s u b a r a c h n o i d h e m o r r h a g e . METHODS: In the first p a r t o f t h is s t u d y , p a t ie n t s w e r e r e t r o s p e c t i v e l y r e v i e w e d to c o r r e l a t e m i d d l e c e r e b r a l a r t e r y absolute b lo o d f l o w v e l o c i t i e s w i t h a n g i o g r a p h i c v a s o s p a s m . In th e s e c o n d p a r t o f th e s t u d y , th e m i d d l e c e r e b r a l artery/ipsilateral e x t r a c r a n i a l i n t e r n a l c a r o t i d a r t e r y v e l o c i t y r a t io ( L i n d e g a a r d ra tio ) w a s p r o s p e c t i v e l y c o r r e ­ lated with a n g i o g r a p h i c v a s o s p a s m . A n g i o g r a p h i c v a s o s p a s m w a s i n d e p e n d e n t l y g r a d e d , b y o b s e r v e r s b l i n d e d to the T C D r e s u lt s , a s e i t h e r n o n e , m i l d (le ss th a n o n e - t h ir d a r t e r y l u m i n a l n a r r o w i n g ) , m o d e r a t e ( o n e - t h ir d to one-half n a r r o w i n g ) , o r s e v e r e ( m o r e t h a n o n e - h a l f n a r r o w i n g ) . T h e s e n s i t iv i t y , s p e c i f i c i t y , l i k e l i h o o d r a t io s fo r positive and n e g a t i v e T C D r e s u l t s , p o s i t i v e a n d n e g a t iv e p r e d i c t i v e v a l u e s , a n d k a n d P v a l u e s w e r e c a l c u l a t e d ....
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199906000-00039
Publisher site
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Abstract

AbstractOBJECTIVEThe purpose of this study was to determine the correlation between transcranial Doppler (TCD) velocities and angiographic vasospasm after aneurysmal subarachnoid hemorrhage.METHODSIn the first part of this study, patients were retrospectively reviewed to correlate middle cerebral artery absolute blood flow velocities with angiographic vasospasm. In the second part of the study, the middle cerebral artery/ipsilateral extracranial internal carotid artery velocity ratio (Lindegaard ratio) was prospectively correlated with angiographic vasospasm. Angiographic vasospasm was independently graded, by observers blinded to the TCD results, as either none, mild (less than one-third artery luminal narrowing), moderate (one-third to one-half narrowing), or severe (more than one-half narrowing). The sensitivity, specificity, likelihood ratios for positive and negative TCD results, positive and negative predictive values, and k and P values were calculated.RESULTSOne hundred one patients were analyzed in the first part of the study, and 44 patients were analyzed in the second part. Interobserver agreement regarding angiographic vasospasm was good (k = 0.86). Despite significant correlation between mean velocities and the degree of vasospasm, the clinical dependability of TCD velocities (evaluated using predictive values and likelihood ratios) was limited. The positive predictive value of velocities of ≥200 cm/s for moderate/severe angiographic vasospasm was 87% but that of lower velocities was approximately 50%. the negative predictive value of velocities of <120 cm/s was 94% but that of higher velocities was approxiametly 75%. only the likelihood ratio for velocity of <120 or ≥200 cm/s were useful (likelihood ratio for negative result=0.17), likehood ratio for positive result=16.39). overall, 57% of patients exhibited maximum velocities in the indeterminate range between 120 and 199 cm/s. Lindegaard ratios did not improve the predictive value of TCD monitoring.CONCLUSIONFor individual patients, only low or very high middle cerebral artery flow velocities (i.e., <120 or ≥200 cm/s) reliably predicted the absence or presence of clinically significant angiographic vasospasm. Intermediate velocities, which were observed for approximately one-half of the patients, were not dependable and should be interpreted with caution

Journal

NeurosurgeryOxford University Press

Published: Jun 1, 1999

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