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

M. Sean Kincaid, Michael J. Souter, Miriam Treggiari, Norbert Yanez, Anne Moore, Arthur M. Lam

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)67-72
Number of pages6
JournalJournal of Neurosurgery
Volume110
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Doppler Transcranial Ultrasonography
Intracranial Vasospasm
Single-Photon Emission-Computed Tomography
Confidence Intervals
Anterior Cerebral Artery
Basilar Artery
Middle Cerebral Artery
Odds Ratio
Posterior Cerebral Artery
Cerebral Angiography
Research Ethics Committees
Subarachnoid Hemorrhage
Blood Vessels
Logistic Models

Keywords

  • Cerebral aneurysm
  • Cerebral angiography
  • Cerebral vasospasm
  • Single-photon emission computed tomography
  • Subarachnoid hemorrhage
  • Transcranial Doppler ultrasonography

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm : Clinical article. / Kincaid, M. Sean; Souter, Michael J.; Treggiari, Miriam; Yanez, Norbert; Moore, Anne; Lam, Arthur M.

In: Journal of Neurosurgery, Vol. 110, No. 1, 01.2009, p. 67-72.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Cerebral aneurysm, Cerebral angiography, Cerebral vasospasm, Single-photon emission computed tomography, Subarachnoid hemorrhage, Transcranial Doppler ultrasonography",
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T1 - Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm

T2 - Clinical article

AU - Kincaid, M. Sean

AU - Souter, Michael J.

AU - Treggiari, Miriam

AU - Yanez, Norbert

AU - Moore, Anne

AU - Lam, Arthur M.

PY - 2009/1

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N2 - 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.

AB - 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.

KW - Cerebral aneurysm

KW - Cerebral angiography

KW - Cerebral vasospasm

KW - Single-photon emission computed tomography

KW - Subarachnoid hemorrhage

KW - Transcranial Doppler ultrasonography

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