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Transcranial Doppler markers of diffusion-perfusion mismatch
Lucas Restrepo1, Alexander Y Razumovsky, Wendy Ziai
1Department of Neurology, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 5-181, Baltimore, MD 21287-6953, USA. lrestre1@jhmi.edu
Summary
Transcranial Doppler (TCD) can identify perfusion-diffusion mismatch in acute ischemic stroke patients. Specific TCD markers, including middle cerebral artery (MCA) and internal carotid artery (ICA) flow velocity asymmetry, show promise for diagnosing salvageable brain tissue.
Area of Science:
- Neurology
- Radiology
- Vascular Ultrasound
Background:
- Acute ischemic stroke evaluation often uses diffusion- and perfusion-weighted magnetic resonance imaging (DWI and PWI) to detect salvageable brain tissue via perfusion-diffusion mismatch.
- DWI and PWI have limitations including availability and inconvenience, necessitating alternative diagnostic methods.
Purpose of the Study:
- To investigate transcranial Doppler (TCD) as a potential diagnostic tool for identifying perfusion-diffusion mismatch in acute ischemic stroke.
Main Methods:
- Retrospective analysis of 22 acute ischemic stroke patients with middle cerebral artery (MCA) territory involvement.
- Performed TCD within 24 hours of MRI with DWI and PWI.
Main Results:
- Cerebral blood flow velocity (CBFV) asymmetry in MCA and intracranial internal carotid artery (ICA), along with a significant ICA-to-MCA gradient, correlated with mismatch presence.
- Combined TCD parameters (MCA CBFV asymmetry ≥ 30% and ICA-to-MCA gradient ≥ 20 cm/sec) demonstrated 75% sensitivity and 80% specificity for mismatch detection.
Conclusions:
- Interhemispheric asymmetry in MCA and ICA CBFVs, and a large ICA-MCA gradient, are associated with diffusion-perfusion mismatch.
- Further prospective studies are needed to validate TCD's role in managing mismatch patients.