Diagnostic TCD for intracranial stenosis in acute stroke patients: experience from a tertiary care stroke center in Karachi, Pakistan

Abstract

BackgroundStroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. There is a need for widely available screening tools to identify patients that are at high risk of stroke due to ICAD for aggressive risk management. This study describes the experience of using the transcranial Doppler (TCD) as a screening tool for this purpose at a tertiary care hospital in a developing country.Methods86 Patients admitted with stroke due to ICAD underwent TCD for six arteries (Right and left middle cerebral arteries, right and left anterior cerebral arteries, right and left posterior cerebral arteries) in addition to the magnetic resonance angiography (MRA) that is done routinely at the stroke center. Arteries were labeled with either <50 or >50% stenosis by TCD using two separate criteria. These findings were compared with those from the MRA which was used as the gold standard. The proportion of patients that had complete exams (all six arteries insonated by TCD) was reported. The success rate of each TCD criteria in detecting arteries with >50% stenosis was also calculated.ResultsThere was an attempt to visualize 516 arteries (86 patients with 6 arteries each) of which 375 (72.7%) were successfully insonated. 38 of the 86 (55.8%) patients had complete examinations. MRA reported 43 (8.3%) arteries as stenosed >50%. The TCD did not categorize any artery as stenosed using either criterion and hence failed to classify any stenosed artery correctly. The positive predictive and sensitivity was 0 for this study and the negative predictive value was 93.3%.ConclusionsThis study indicates the poor sensitivity of TCD to be a reliable screening tool for the presence of ICAD in the South Asian population in a real life clinical setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1289-3) contains supplementary material, which is available to authorized users.

Role of Noninvasive Imaging of Cerebral Arterial System in Ischemic Stroke: Comparison of Transcranial Color-coded Doppler Sonography with Magnetic Resonance Angiography

“…A recent study done using TCD by Kamal et al ., in South Asian population reported an insonation failure rate of 19.6% in males and 35.7% in females. [ 27 ]…”

Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion: a systematic review

“…On the basis of their full-text articles, ten studies were not included in the final analysis [9–18]. Principal reasons were unknown or unclear time interval between symptom onset and reference/index imaging and/or between reference and index imaging [9, 10, 12, 14–18], the use of contrast-enhanced transcranial sonography either exclusively or in combination with non-contrast ultrasound without reporting outcomes separately for each group [9, 11, 13], or a non-stroke population [12].…”

“…Some papers reporting negative results in their evaluation of diagnostic accuracy of transcranial ultrasonography in acute stroke were not included, since they did not meet our inclusion criteria [18, 56]. Thus, Kamal et al [18] studied cerebral artery stenosis in stroke patients from a South Asian population, and concluded that TCD has poor sensitivity for detection of arterial stenosis when compared to MRA. This study was not included in the qualitative analysis because of the unclear time interval between stroke onset and examinations and between index and reference tests.…”

A systematic review and meta-analysis on transcranial Doppler in diagnosing ischemic cerebrovascular disease

“…Transcranial Doppler ultrasound imaging technology is a non-invasive inspection method, which can reduce the risk of patients being irradiated. At the same time, transcranial Doppler ultrasound imaging has the advantages of low price, simple operation and superior detection effect (32). Today, transcranial Doppler ultrasound imaging can be used to diagnose cerebral vascular stenosis, occlusion, and spasm (33).…”