Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm

Clinical article

M. Sean Kincaid Departments of Anesthesiology

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 M.D.
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Michael J. Souter Departments of Anesthesiology
Neurological Surgery and

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 M.B., Ch.B.
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Miriam M. Treggiari Departments of Anesthesiology
Neurological Surgery and

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 M.D., Ph.D.
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N. David Yanez Biostatistics University of Washington, Seattle, Washington

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 Ph.D.
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Anne Moore Neurological Surgery and

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 B.S.N., R.V.T.
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Arthur M. Lam Departments of Anesthesiology
Neurological Surgery and

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 M.D.
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Object

The goal of this study was to assess the accuracy of the routine clinical use of transcranial Doppler (TCD) ultrasonography and SPECT in predicting angiographically demonstrated vasospasm.

Methods

Following receipt of institutional review board approval, the authors reviewed the records of patients with subarachnoid hemorrhage who had been admitted between 2004 and 2005 and underwent TCD ultrasonography and SPECT evaluations within 24 hours of cerebral angiography. Patients were categorized based on the presence or absence of vasospasm and/or hypoperfusion in the anterior cerebral arteries (ACAs), middle cerebral arteries (MCAs), and basilar arteries (BAs) or posterior cerebral arteries (PCAs) according to each imaging modality. Logistic regression was used to estimate the odds ratio (OR) of an angiographically demonstrated vasospasm also detected on TCD ultrasonography and SPECT.

Results

One hundred fifty-two patients (101 women) with a mean age (± standard deviation) of 53 ± 13 years were included in the study. In the ACA, the OR of a vasospasm on TCD ultrasonography was 27 (95% confidence interval [CI] 3–243) and on SPECT 0.97 (95% CI 0.36–2.6); in the MCA, 17 (95% CI 5.4–55) and 2.0 (95% CI 0.71–5.5), respectively; in the BA, 4.4 (95% CI 0.72–27) and 5.6 (95% CI 0.89–36), respectively. There was no substantial change in the relative odds of a vasospasm when the findings on TCD ultrasonography and SPECT were considered jointly.

Conclusions

Transcranial Doppler ultrasonography appears to be highly predictive of an angiographically demonstrated vasospasm in the MCA and ACA; however, its diagnostic accuracy was lower with regard to vasospasm in the BA. Single-photon emission computed tomography was not predictive of a vasospasm in any of the vascular territories assessed.

Abbreviations used in this paper:

ACA = anterior cerebral artery; BA = basilar artery; CBF = cerebral blood flow; CI = confidence interval; DIND = delayed ischemic neurological deficit; MCA = middle cerebral artery; OR = odds ratio; PCA = posterior cerebral artery; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage; TCD = transcranial Doppler; VA = vertebral artery.
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