Brunser Alejandro M, Lavados Pablo M, Hoppe Arnold, Lopez Javiera, Valenzuela Marcela, Rivas Rodrigo
Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo Santiago Chile, Av Manquehue Norte 1410, Vitacura 7630000, Santiago, Chile.
Stroke. 2009 Jun;40(6):2037-41. doi: 10.1161/STROKEAHA.108.542704. Epub 2009 Apr 9.
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.
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.
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.
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.
急性缺血性脑卒中且伴有颅内动脉阻塞的患者预后较差，24小时内病情恶化的可能性很高。我们旨在评估与作为标准的CT血管造影相比，动力运动模式多普勒（PMD-TCD）在诊断发病时间小于24小时的缺血性脑卒中患者颅内动脉阻塞时的诊断准确性。
连续收治至急诊科的急性缺血性脑卒中患者在相差6小时内接受了高分辨率脑CT血管造影和PMD-TCD检查。
共纳入100例患者。PMD-TCD显示34例颅内闭塞，CT血管造影显示33例。PMD-TCD有6例假阳性和4例假阴性诊断。在检测任何特定动脉的动脉闭塞方面，PMD-TCD的阳性似然比为13.7，阴性似然比为0.19，敏感性为81.8%，特异性为94%。大脑中动脉的结果为：阳性似然比24.6，阴性似然比0.045，敏感性95.6%，特异性96.2%。前循环的结果为：阳性似然比18.5，阴性似然比0，敏感性100%，特异性94.5%。后循环的结果为：阳性似然比>1000，阴性似然比0.42，敏感性57.1%，特异性100%。当PMD-TCD为阳性时，任何入院时美国国立卫生研究院卒中量表评分的患者中任何闭塞动脉的验后概率均增加，但在7至15分的美国国立卫生研究院卒中量表评分中尤为显著。
与CT血管造影相比，PMD-TCD在诊断急性缺血性脑卒中患者的动脉闭塞方面是有效的，尤其是在大脑中动脉阻塞时。
