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Transcranial Doppler Ultrasonography for Diagnosis of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Mean Blood Flow Velocity Ratio of the Ipsilateral and Contralateral Middle Cerebral Arteries.
MedLine Citation:
PMID:  21558976     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Transcranial Doppler (TCD) is widely accepted to monitor cerebral vasospasm after subarachnoid hemorrhage (SAH); however, its predictive value remains controversial. OBJECT:: To investigate the predictive reliability of an increase in the mean blood flow velocity (mBFV) ratio of the ipsilateral to contralateral middle cerebral arteries (I/C mBFV) compared to the conventional absolute flow velocity. METHODS:: We retrospectively investigated the clinical and radiologic data of consecutive patients with SAH admitted from July 2003 to August 2009 who underwent TCD ultrasonography. The highest mBFV value in bilateral middle cerebral arteries was recorded, while delayed cerebral ischemia (DCI) was defined as neurological deficits or computed tomographic evidence of cerebral infarction caused by vasospasm. The ipsilateral side was defined as the side with higher mBFV value when evaluating the I/C mBFV. We thus elucidated the reliability of this rate, comparing to the conventional method for predicting DCI with receiver operating characteristic (ROC) analysis. RESULTS:: One hundred and forty-two patients were retrospectively analyzed with specific data from 1262 TCD studies. The ROC curve showing the overall predictive value for DCI had an area under the curve of 0.86 (95% confidence interval: 0.76 - 0.96) when the I/C mBFV was used versus 0.80 (0.71 - 0.88) using the absolute flow velocity. The threshold value that best discriminated between patients with and without DCI was I/C mBFV of 1.5. CONCLUSION:: In patients with SAH, the I/C mBFV demonstrated a more significant correlation to vasospasm than the absolute mean flow velocity.
Ryuta Nakae; Hiroyuki Yokota; Daizo Yoshida; Akira Teramoto
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-06
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Emergency and Critical Care Medicine; 2Department of Neurosurgery; Nippon Medical School, Tokyo, Japan.
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