Is Transcranial Doppler Ultrasonography Old-fashioned?: One Institutional Validity Study

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (SAH) can lead to delayed cerebral vasospasm, a significant cause of morbidity and mortality.
• Early detection of vasospasm is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

• To investigate the correlation between transcranial Doppler (TCD) ultrasonography parameters and the occurrence of clinical vasospasm after SAH.
• To identify specific TCD metrics that can reliably predict vasospasm.

Main Methods:

• A cohort of 40 patients with aneurysmal SAH underwent TCD examinations.
• Key parameters measured included mean blood flow velocity (BFVm), highest systolic blood flow velocity (BFVh), and Lindegaard ratio (LR) in the middle cerebral artery.
• Univariate and receiver operating characteristic (ROC) analyses were used to correlate TCD findings with clinical vasospasm.

Main Results:

• Clinical vasospasm developed in 12 patients (30%).
• The most effective TCD parameters for detecting vasospasm were the differences in BFVm (7 cm/s), BFVh (11.5 cm/s), and LR (0.45) between the first and third TCD tests.
• The positive predictive value for any of these parameters was 60%, with a negative predictive value of 100%.

Conclusions:

• Transcranial Doppler (TCD) remains a valuable tool for screening clinical vasospasm post-SAH.
• The identified TCD parameter changes demonstrate potential for predicting vasospasm.
• Further prospective studies are warranted to confirm the predictive accuracy of these specific TCD metrics.