Effect of transcranial Doppler intensity on successful recording in Japanese patients

doi:10.1016/0301-5629(96)00032-4

Ultrasound in Medicine & Biology

Volume 22, Issue 6, 1996, Pages 701-705

https://doi.org/10.1016/0301-5629(96)00032-4 Get rights and content

Abstract

The major limitation of transcranial Doppler sonography (TCD) is the failure to obtain data for all patients. The purpose of this study was to determine in detail the effect of increasing ultrasonic acoustic intensity on the rate of successful recording of intracranial blood velocity signals. The study was performed in 239 Japanese patients using a 2-MHz range-gated, pulsed-wave TCD. The middle cerebral artery flow signals were recorded at 76, 152, 228, 304, 380, 456 and 532 mW/cm² and the results analyzed by age, gender and intensity. The rate of successful recording showed significant increase with the ultrasonic intensity in both genders (45.7% at 76 mW/cm² vs. 81.1% at 532 mW/cm² in males and 29.5% vs. 60.7% in females). However, recording was only successful in 54% of aged (50–89 y) female patients at the highest ultrasonic intensity used. It should be possible to significantly increase TCD usefulness in an aging Japanese population by further increasing TCD acoustic intensity within safety limitation.

References (17)

H Maeda et al.
A validation study on the reproducibility of transcranial Doppler velocimetry
Ultrasound Med Biol
(1990)
R Aaslid et al.
Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries
J Neurosurg
(1982)
American Institute of Ultrasound in Medicine (AIUM)
Bioeffects and safety of diagnostic ultrasound
(1993)
U Bogdahn et al.
Contrast-enhanced transcranial color-coded real-time sonography. Results of a phase-two study
Stroke
(1993)
A Bruno et al.
A reason for failure to obtain transcranial Doppler flow signals: Hyperostosis of the skull
Stroke
(1988)
LR Caplan et al.
Transcranial Doppler ultrasound: Present status
Neurology
(1990)
Center for Devices and Radiological Health
Revised 510(k) diagnostic ultrasound guidance for 1993
(1993)
A Eden
Transcranial Doppler ultrasonography and hyperostosis of the skull
Stroke
(1988)

There are more references available in the full text version of this article.

Cited by (31)

Non-invasive Detection of Diffuse Intracranial Vertebrobasilar Artery Stenosis: A Prospective Comparison with Digital Subtraction Angiography
2022, Ultrasound in Medicine and Biology
Citation Excerpt :
The acoustic window is the major limitation of TCD and TCCD, especially TCCD. Previous studies have found that the rates of inadequate temporal acoustic window of TCD were 8.2%–22.9%, and the rate of inadequate occipital acoustic window was 9.0% (Itoh et al. 1993; Yagita et al. 1996; Marinoni et al. 1997). Nevertheless, the inadequate detection rates for middle cerebral artery via the temporal acoustic window by TCCD were 37.6%–39.6%, and those for VA or BA via the occipital acoustic window were 10%–62% (Stolz et al. 2002; Yoshimura et al. 2009; Pade et al. 2011; Liu et al. 2021).
The aim of this study was to prospectively evaluate diffuse intracranial vertebrobasilar artery stenosis by ultrasonic examination with digital subtraction angiography as the reference. Five hundred forty-one vertebrobasilar arteries with a normal lumen or intracranial stenosis were enrolled. Peak systolic velocity, mean flow velocity and end-diastolic velocity (EDV) at the intracranial vertebrobasilar arteries and extracranial vertebral arteries (VAs) were measured. The resistance index (RI) at extracranial VAs and the difference between the RI of extracranial VAs and the RI of the extracranial internal carotid artery (RI_ica) were calculated. Compared with normal arteries, all stenotic arteries were divided into the high-velocity group (focal stenosis, multiple-segment stenosis and multiple-artery stenosis) and low-velocity group (critical stenosis and long stenosis). The consistency between ultrasonic examination and digital subtraction angiography for evaluation of vertebrobasilar arteries with multiple-segment stenosis and multiple-artery stenosis was not favorable when applying the widely used Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis criteria (κ = 0.442 and 0.438, respectively). The optimal low-velocity criteria for identifying intracranial vertebrobasilar arteries with critical stenosis and long stenosis were determined by receiver operating characteristic curve analysis and were as follows: EDV ≤15 cm/s and RI ≥0.68 at the extracranial VA and RIica ≥0.10.
Autodetect extracranial and intracranial artery stenosis by machine learning using ultrasound
2020, Computers in Biology and Medicine
Citation Excerpt :
Transcranial color-coded Doppler (TCCD) is a noninvasive procedure for assessing intracranial arteries [8,9]. But in some patients, TCCD might not be able to be performed because of temporal bone window failure, especially in elderly Asians [10,11]. Computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) can also be used for identifying carotid artery stenosis, but these methods are expensive and need contrast enhancement for intracranial arteries [12,13].
and Purpose: This study proposed a machine learning method for identifying ≥50% stenosis of the extracranial and intracranial arteries.
A total of 8211 patients with both carotid ultrasound and cerebral angiography were enrolled. Support vector machine (SVM) was employed as the machine learning classifier. Carotid Doppler parameters and transcranial Doppler parameters were used as the input features. Feature selection was performed using the Extra-Trees (extremely randomized trees) method.
For the machine learning method, the sensitivities and specificities of identifying stenosis of the extracranial arteries were 88.5%–100% and 96.0%–100%, respectively. The sensitivities and specificities of identifying stenosis of the intracranial arteries were 71.7%–100% and 88.9%–100%, respectively.
The SVM classifier with feature selection is an efficient method for identifying the stenosis of both intracranial and extracranial arteries. Comparing with traditional Doppler criteria, this machine learning method achieves up to 20% higher in accuracy and 45% in sensitivity, respectively.
Dynamic Cerebral Autoregulation Assessment Using Extracranial Internal Carotid Artery Doppler Ultrasonography
2017, Ultrasound in Medicine and Biology
Transcranial Doppler ultrasonography of the middle cerebral artery (MCA) is frequently used to assess dynamic cerebral autoregulation (dCA); however, this is difficult in patients with poor temporal bone windows. In the study described here, we investigated the agreement and sensitivity of dCA indices determined from the extracranial internal carotid artery (ICA) and those determined from the MCA. Measurements for 32 stroke patients and 59 controls were analyzed. Measurement of the mean flow correlation index (Mx) and transfer function analysis based on spontaneous blood pressure fluctuation were simultaneously performed for the extracranial ICA and MCA. The mean values of Mx and phase shift did not significantly differ between the ICA and MCA (mean difference: Mx = 0.01; phase shift of very low frequency [VLF] = 0.7°, low frequency [LF] = 3.3° and high frequency = 4.5°), but the gains in VLF and LF in the ICA were significantly lower than those in the MCA (mean difference: gain of VLF = −0.13, gain of LF = −0.10). The intra-class correlation coefficient between the dCA indices of the ICA and MCA was favorable in Mx (0.76) and the phase shift of VLF (0.72). The area under the receiver operating characteristic curve for stroke diagnosis did not differ among the dCA indices. We conclude that dCA assessed from the ICA is as effective as that from the MCA, but the results are not interchangeable.
Decreased Flow Velocity with Transcranial Color-Coded Duplex Sonography Correlates with Delayed Cerebral Ischemia due to Peripheral Vasospasm of the Middle Cerebral Artery
2016, Journal of Stroke and Cerebrovascular Diseases
Despite intensive therapy, vasospasm remains a major cause of delayed cerebral ischemia (DCI) in worsening patient outcome after aneurysmal subarachnoid hemorrhage (aSAH). Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) are noninvasive modalities that can be used to assess vasospasm. However, high flow velocity does not always reflect DCI. The purpose of this study was to investigate the utility of TCD/TCCS in decreasing permanent neurological deficits.
We retrospectively enrolled patients with aSAH who were treated within 72 hours after onset. TCCS was performed every day from days 4 to 14. Peak systolic velocity (PSV), mean velocity (MV), and pulsatility index were recorded and compared between DCI and non-DCI patients. In patients with DCI, endovascular therapy was administered to improve vasospasm, which led to a documented change in velocity.
Of the 73 patients, 7 (9.6%) exhibited DCI. In 5 of the 7 patients, DCI was caused by vasospasm of M2 or the more peripheral middle cerebral artery (MCA), and the PSV and MV of the DCI group were lower than those of the non-DCI group after day 7. Intra-arterial vasodilator therapy (IAVT) was performed for all patients with DCI immediately to increase the flow volume by the next day.
Increasing flow velocity cannot always reveal vasospasm excluding M1. In patients with vasospasm of M2 or more distal arteries, decreasing flow velocity might be suggestive of DCI. IAVT led to increases in the flow velocity through expansion of the peripheral MCA.
Cranioplasty and Duraplasty with Transcranial Color-Coded Duplex Sonography after Aneurysmal Subarachnoid Hemorrhage
2015, Journal of Stroke and Cerebrovascular Diseases
Transcranial color-coded duplex sonography (TCCS) is a noninvasive technique for monitoring of cerebral vasospasm after neurosurgery for aneurismal subarachnoid hemorrhage. In this surgery, surgical materials are used. The goal of the study was to identify materials that can be used with ultrasound and to propose methods for cranioplasty and duraplasty using materials that permit TCCS.
The chosen neurosurgical materials were titanium mesh plate (TMP), Gore-tex, SEAMDURA, gelatinous sponge, and oxidized cellulose. B-mode imaging was recorded with the materials placed between urethane resin 10 mm in diameter and the urethane phantom model. TCCS was performed to detect middle cerebral artery flow through TMP and Gore-tex.
TMP and SEAMDURA permitted penetration of ultrasound in B-mode and Doppler imaging, but the other materials did not do so.
A postcraniotomy window (PCW) on a line extending from the horizontal portion of M1 using only TMP permitted flow imaging with TCCS. In external decompression, TCCS was effective only without use of Gore-tex around the postcraniotomy window. This method allows the middle cerebral artery flow to be detected easily.
Intraoperative Cerebral Autoregulation Assessment Using Ultrasound-Tagged Near-Infrared-Based Cerebral Blood Flow in Comparison to Transcranial Doppler Cerebral Flow Velocity: A Pilot Study
2015, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Of note, while a 40% failure rate for TCD monitoring may appear excessive, it is not inconsistent with other such clinical studies. In a study of 239 patients, it was reported that TCD was unsuccessful in 46% of female patients even at highest ultrasound intensity, and another study of 176 carotid endarterectomies reported an inability to monitor TCD hemodynamics in>40% of patients.13,14 Because agreement was demonstrated between Mx and CFIx in determining the presence or absence of CA during CPB, and given the high correlation (r2 = 0.828; p = 0.003) between LLA determined independently by each device, as show in Figure 2, a further analysis of CA employing only CFIx data during pre- and post-CPB study periods was undertaken.
This was a pilot study comparing the ability of a new ultrasound-tagged near-infrared (UT-NIR) device to detect cerebral autoregulation (CA) in comparison to transcranial Doppler (TCD).
An unblinded, prospective, clinical feasibility study.
Tertiary-care university hospital cardiac surgical operating rooms.
Twenty adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
There were no clinical interventions based on study monitoring devices, but a continuous correlation analysis of digital data from transcranial Doppler (TCD) velocity was compared with a novel UT-NIR device and correlation analysis of change signals versus mean arterial pressure was performed in order to detect presence or absence of intact CA and for determination of the lower limit of cerebral autoregulation during CPB.
Similar and highly significant concordance (κ = 1.00; p<0.001) was demonstrated between the 2 methodologies for determination of CA, indicating good correlation between the 2 methodologies. Intact CA was absent in 2 patients during CPB, and both devices were able to detect this.
To the authors’ knowledge this is the first clinical report of a UT-NIR device that shows promise as a clinically useful modality for detection of CA and the lower limit of cerebral autoregulation. The utility of UT-NIR was demonstrated further during times at which extensive usage of electrocautery or functional absence of the transcranial window rendered TCD uninterpretable.

View all citing articles on Scopus

View full text

Original contributionEffect of transcranial Doppler intensity on successful recording in Japanese patients

Abstract

Ultrasound Med Biol

Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries

J Neurosurg

Bioeffects and safety of diagnostic ultrasound

Contrast-enhanced transcranial color-coded real-time sonography. Results of a phase-two study

Stroke

A reason for failure to obtain transcranial Doppler flow signals: Hyperostosis of the skull

Stroke

Transcranial Doppler ultrasound: Present status

Neurology

Revised 510(k) diagnostic ultrasound guidance for 1993

Transcranial Doppler ultrasonography and hyperostosis of the skull

Stroke

Original contribution
Effect of transcranial Doppler intensity on successful recording in Japanese patients