Effects of poor bone window on the assessment of cerebral autoregulation with transcranial Doppler sonography – A source of systematic bias and strategies to avoid it

Lorenz, Matthias; Loesel, Nadine; Thoelen, Nina; Gonzalez, M.; Lienerth, Christian; Dvorak, Florian; Rölz, Waltraud; Humpich, Marek; Sitzer, Matthias

doi:10.1016/j.jns.2009.02.329

Cited by 7 publications

(4 citation statements)

References 36 publications

(49 reference statements)

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“…Numerous studies have shown that MCA diameter in humans remains relatively constant under a variety of hemodynamic conditions [48][49][50]. However, there is a possibility that the measurement quality differs between the centers [51], leading to a higher spread in transfer function outcomes.…”

Section: Discussionmentioning

confidence: 99%

Transfer function analysis for the assessment of cerebral autoregulation using spontaneous oscillations in blood pressure and cerebral blood flow

Abeelen¹,

Beek²,

Slump

et al. 2014

Medical Engineering & Physics

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Section: Discussionmentioning

confidence: 99%

Transfer function analysis for the assessment of cerebral autoregulation using spontaneous oscillations in blood pressure and cerebral blood flow

Abeelen¹,

Beek²,

Slump

et al. 2014

Medical Engineering & Physics

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“…It is a highly operatordependent instrument. The reliability of TCD in measuring CBF at the MCA has been reported to be between 0.76 and 0.82 depending on the patient's bone window condition (Lorenz et al, 2009;Muñoz Venturelli et al, 2017). The reliability of the TCD measurements in the ACA and PCA may even be lower than those in the MCA.…”

Section: Discussionmentioning

confidence: 99%

“…MR technics may provide additional information on the flow velocity and direction of blood flow in the CoW, but these methods are time-consuming and expensive (Van Laar et al, 2006;Amin-Hanjani et al, 2015;Hartkamp et al, 2018). TCD is an alternative noninvasive bedside tool that can be used to assess the proximal cerebral blood flow (CBF) but is highly operator dependent and limited by patients' bone window conditions (Lui et al, 2005;Lorenz et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Validation of a cerebral hemodynamic model with personalized calibration in patients with aneurysmal subarachnoid hemorrhage

Shen

Harst²,

Wei³

et al. 2022

Front. Bioeng. Biotechnol.

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This study aims to validate a numerical model developed for assessing personalized circle of Willis (CoW) hemodynamics under pathological conditions. Based on 66 computed tomography angiography images, investigations were obtained from 43 acute aneurysmal subarachnoid hemorrhage (aSAH) patients from a local neurovascular center. The mean flow velocity of each artery in the CoW measured using transcranial Doppler (TCD) and simulated by the numerical model was obtained for comparison. The intraclass correlation coefficient (ICC) over all cerebral arteries for TCD and the numerical model was 0.88 (N = 561; 95% CI 0.84–0.90). In a subgroup of patients who had developed delayed cerebral ischemia (DCI), the ICC had decreased to 0.72 but remained constant with respect to changes in blood pressure, Fisher grade, and location of ruptured aneurysm. Our numerical model showed good agreement with TCD in assessing the flow velocity in the CoW of patients with aSAH. In conclusion, the proposed model can satisfactorily reproduce the cerebral hemodynamics under aSAH conditions by personalizing the numerical model with TCD measurements.Clinical trial registration: [http://www.trialregister.nl/], identifier [NL8114].

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“…Bone windows become closer and denser with increasing age. This is a problem of our technique, as the ageing population is the target of this approach [18,19] . Second, this technique is dependent on the investigator's skills.…”

Section: Discussionmentioning

confidence: 99%

TCD-Profiling Using AVERAGE. A New Technique to Evaluate Transcranial Doppler Ultrasound Flow Spectra of Subjects with Cerebral Small Vessel Disease

Fisse

Pueschel²,

Deppe³

et al. 2015

Cerebrovasc Dis

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Background: There is an unmet need for screening methods to detect and quantify cerebral small vessel disease (SVD). Transcranial Doppler ultrasound (TCD) flow spectra of the larger intracranial arteries probably contain relevant information about the microcirculation. However, it has not yet been possible to exploit this information as a valuable biomarker. Methods: We developed a technique to generate normalized and averaged flow spectra during middle cerebral artery Doppler ultrasound examinations. Second, acceleration curves were calculated, and the absolute amount of the maximum positive and negative acceleration was calculated. Findings were termed ‘TCD-profiling coefficient' (TPC). Validation study: we applied this noninvasive method to 5 young adults for reproducibility. Degenerative microangiopathy study: we also tested this new technique in 30 elderly subjects: 15 free of symptoms but with MRI-verified presence of cerebral SVD, and 15 healthy controls. SVD severity was graded according to a predefined score. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) study: TPC values of 10 CADASIL patients were compared with those of 10 healthy controls. Pulse wave analysis and local measurements of carotid stiffness were also performed. CADASIL patients were tested for cognitive impairment with the Montreal Cognitive Assessment scale. White matter and basal ganglia lesions in their cerebral MRI were evaluated according to the Wahlund score. Results: Validation study: the technique delivered reproducible results. Degenerative microangiopathy study: patients with SVD had significantly larger TPCs compared with controls (SVD: 2,132; IQR 1,960-2,343 %/s vs. controls: 1,935; IQR 1,782-2,050 %/s, p = 0.01). TPC values of subjects with SVD significantly correlated with SVD severity scores (R = 0.58, n = 15, p < 0.05). CADASIL study: TPC values of CADASIL patients were significantly higher than values of the controls (CADASIL: 2,504; IQR 2,308-2,930 %/s vs. controls 2,084; 1,839-2,241 %/s, p = 0.008), and also significantly higher than the TPC values of the patients with SVD from the degenerative microangiopathy study (p = 0.007). CADASIL patients had significantly worse cognitive test results than healthy controls. Conclusion: TCD-profiling detects impairment of the cerebral microcirculatory state. The suitability of the TCD-profiling for the evaluation of cerebral microangiopathy was confirmed.

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Effects of poor bone window on the assessment of cerebral autoregulation with transcranial Doppler sonography – A source of systematic bias and strategies to avoid it

Cited by 7 publications

References 36 publications

Transfer function analysis for the assessment of cerebral autoregulation using spontaneous oscillations in blood pressure and cerebral blood flow

Transfer function analysis for the assessment of cerebral autoregulation using spontaneous oscillations in blood pressure and cerebral blood flow

Validation of a cerebral hemodynamic model with personalized calibration in patients with aneurysmal subarachnoid hemorrhage

TCD-Profiling Using AVERAGE. A New Technique to Evaluate Transcranial Doppler Ultrasound Flow Spectra of Subjects with Cerebral Small Vessel Disease

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