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Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Echo-enhanced transcranial color-coded duplex sonography in the diagnosis of cerebrovascular events: a validation
1Department of Neurology, University of Technology Dresden, Dresden, Germany.
Insights
Echo-enhanced transcranial color-coded duplex sonography (eTCCD) is a valid diagnostic tool for intracranial arteries. This technique, using echo-enhancing agents, offers high accuracy in assessing cerebrovascular conditions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Transcranial color-coded duplex sonography (TCCD) is crucial for evaluating intracranial arteries in acute stroke patients.
- Echo-enhancing agents (EEAs) are vital for visualizing intracranial vessels in up to 30% of patients due to acoustic bone windows.
- Digital subtraction angiography (DSA) is the gold standard for cerebrovascular imaging.
Purpose of the Study:
- To assess the diagnostic efficacy of echo-enhanced TCCD (eTCCD).
- To compare eTCCD findings with DSA in patients with cerebrovascular symptoms.
- To determine the utility of eTCCD as an alternative imaging technique.
Main Methods:
- Prospective evaluation of patients undergoing eTCCD followed by DSA over 24 months.
- Administration of Levovist as an echo-enhancing agent.
- Analysis of eTCCD findings by two blinded reviewers correlated with DSA results.
Main Results:
- 132 patients (164 datasets) were analyzed.
- eTCCD demonstrated high diagnostic accuracy: 82% sensitivity, 98% specificity, 99% positive predictive value, and 75% negative predictive value.
- Interobserver agreement was nearly perfect (kappa=0.92).
Conclusions:
- eTCCD offers high diagnostic validity for major intracranial arteries.
- Normal eTCCD findings by experienced sonographers may eliminate the need for further imaging.
- eTCCD is a potentially useful alternative imaging technique for acute ischemic stroke patients ineligible for other angiographic methods.
Background And Purpose:
Transcranial color-coded duplex sonography (TCCD) is a diagnostic technique for evaluation of intracranial arteries in patients with acute stroke. Echo-enhancing contrast agents (EEAs) are necessary to visualize intracranial vessels in up to 30% of patients because of limited acoustic bone windows. In this study, we assessed the diagnostic efficacy of echo-enhanced TCCD (eTCCD) in correlation with the gold standard, digital subtraction angiography (DSA).
Methods:
We prospectively evaluated all patients with eTCCD who subsequently underwent DSA for evaluation of cerebrovascular symptoms over a 24-month period. We administered Levovist as an EEA. Two blinded reviewers analyzed all eTCCD findings and correlated them with DSA.
Results:
We included 132 consecutive patients (40 women, 92 men; mean age, 58 +/- 14 years) with 164 datasets: 24/164 had normal findings, 98/164 had abnormalities of extracranial carotid arteries, 32/164 had abnormalities of intracranial arteries, and 21/164 had abnormalities in vertebrobasilar circulation as determined by DSA. For eTCCD, we found a sensitivity of 82% (95% confidence interval [CI]: 75%-90%), a specificity of 98% (95% CI: 90%-100%), a positive predictive value of 99% (95% CI: 94%-100%), and a negative predictive value of 75% (95% CI: 64%-85%); 7/164 (4%) examinations were inconclusive because of insufficient bone windows. The interobserver agreement was almost perfect (kappa value, 0.92; 95% CI: 0.87-0.97).
Conclusion:
eTCCD provides high diagnostic validity for the status of the major intracranial arteries. In particular, a normal vessel status reliably assessed by an experienced sonographer could supersede further imaging procedures. In patients with acute ischemic stroke not eligible for established angiographic techniques, eTCCD may be useful as an alternative imaging technique.
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