| Derivation of power M-mode transcranial Doppler criteria for angiographic proven MCA occlusion. | |
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MedLine Citation:
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PMID: 17032381 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Stringent transcranial Doppler (TCD) criteria for diagnosing occlusion are needed for more reliable TCD performance at bedside in the acute stroke setting. SUBJECTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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. |
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Authors:
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Maher Saqqur; Michael D Hill; Andrei V Alexandrov; Jayanta Roy; Marcia Schebel; Andrea Krol; Zsolt Garami; Ashfaq Shuaib; Andrew M Demchuk |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of neuroimaging : official journal of the American Society of Neuroimaging Volume: 16 ISSN: 1051-2284 ISO Abbreviation: J Neuroimaging Publication Date: 2006 Oct |
Date Detail:
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Created Date: 2006-10-11 Completed Date: 2006-12-19 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 9102705 Medline TA: J Neuroimaging Country: United States |
Other Details:
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Languages: eng Pagination: 323-8 Citation Subset: IM |
Affiliation:
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Department of Medicine, University of Alberta, Alberta, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angiography, Digital Subtraction Blood Flow Velocity Constriction, Pathologic Female Humans Infarction, Middle Cerebral Artery / physiopathology, radiography, ultrasonography* Male Middle Aged Middle Cerebral Artery / ultrasonography* Ultrasonography, Doppler, Transcranial* Vascular Resistance |
| Grant Support | |
ID/Acronym/Agency:
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1 K23 NS02229-01/NS/NINDS NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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