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Updated: Jun 24, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Accuracy of transcranial Doppler compared with CT angiography in diagnosing arterial obstructions in acute ischemic
Alejandro M Brunser1, Pablo M Lavados, Arnold Hoppe
1Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo Santiago Chile, Av Manquehue Norte 1410, Vitacura 7630000, Santiago, Chile. abrunser@alemana.cl
Insights
Power Motion Mode Doppler (PMD-TCD) accurately diagnoses intracranial arterial obstructions in acute ischemic stroke patients. This non-invasive technique shows high sensitivity and specificity, especially for middle cerebral artery occlusions.
Area of Science:
- Neurology
- Medical Imaging
- Vascular Medicine
Background:
- Acute ischemic stroke with intracranial arterial obstructions carries a poor prognosis.
- Early diagnosis of arterial blockages is critical for timely intervention and improved patient outcomes.
Purpose of the Study:
- To assess the diagnostic accuracy of Power Motion Mode Doppler (PMD-TCD) for intracranial arterial obstructions.
- To compare PMD-TCD against CT angiography (CTA) as the gold standard in acute ischemic stroke patients.
Main Methods:
- 100 patients with ischemic stroke (<24 hours symptom onset) underwent both PMD-TCD and high-resolution CTA.
- Diagnostic performance metrics including sensitivity, specificity, and likelihood ratios were calculated for PMD-TCD.
Main Results:
- PMD-TCD detected 34 occlusions versus 33 by CTA, with high overall sensitivity (81.8%) and specificity (94%).
- Exceptional accuracy was observed for middle cerebral artery occlusions (sensitivity 95.6%, specificity 96.2%).
- PMD-TCD demonstrated excellent performance in anterior circulation and very high specificity in posterior circulation.
Conclusions:
- PMD-TCD is a valid and accurate tool for diagnosing arterial occlusions in acute ischemic stroke.
- The technique is particularly effective for identifying middle cerebral artery obstructions, offering a reliable alternative to CTA.
Background And Purpose:
Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of <24 hours.
Methods:
Consecutive patients presenting with acute ischemic stroke to the emergency department underwent high-resolution brain CT angiography and PMD-TCD within a 6-hour difference.
Results:
A total of 100 patients were included. PMD-TCD demonstrated 34 intracranial occlusions and CTA 33. There were 6 false-positives and 4 false-negative diagnoses with PMD-TCD. PMD-TCD had a positive likelihood ratio of 13.7, a negative likelihood ratio of 0.19, sensitivity of 81.8%, and specificity of 94% for detecting an arterial occlusion in any specific artery. Results for the middle cerebral artery were: positive likelihood ratio 24.6, negative likelihood ratio 0.045, sensitivity 95.6%, and specificity 96.2%. For the anterior circulation, the results were: positive likelihood ratio 18.5, negative likelihood ratio 0, sensitivity 100%, and specificity 94.5%. For the posterior circulation, the results were: positive likelihood ratio >1000, negative likelihood ratio 0.42, sensitivity 57.1%, and specificity 100%. The post-test probability for any occluded artery when PMD-TCD was positive increased for any admission National Institutes of Health Stroke Scale score but was especially remarkable for National Institutes of Health Stroke Scale scores between 7 and 15 points.
Conclusions:
PMD-TCD is valid compared with CT angiography for the diagnosis of arterial occlusions in patients with acute ischemic stroke, especially in middle cerebral artery obstructions.
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