Clinical Investigation Center (CIC), 1415, INSERM, Department of Interventional Neuroradiology, Tours University Hospital, Tours, France.
Clinical Investigation Center (CIC), 1415, INSERM, Tours University Hospital, Tours, France.
Clin Neurol Neurosurg. 2024 Oct;245:108506. doi: 10.1016/j.clineuro.2024.108506. Epub 2024 Aug 12.
Transcranial Doppler (TCD) ultrasound may enhance the swift diagnosis of large vessel occlusion (LVO) in patients with a clinical suspicion of acute ischemic stroke (AIS). This is a comprehensive review of the literature on the use and performance of TCD ultrasound in diagnosing AIS caused by LVO.
We conducted a systematic search in PubMed and Google scholar to identify studies reporting data on TCD biomarkers for LVO diagnosis and management of AIS. The main outcomes of interest were the identified TCD-derived biomarkers performances (specificity, sensitivity, predictive values) for LVO diagnosis.
A total of 170 studies were screened, of which 7 (4.1 %) studies with a total of 2260 patients (mean age: 65.3 +/- 4.5 years, 1114 (49.3 %) females) were included in this review. Most of the studies were prospective (n=5, 71.4 %), all of the studies had an overall low risk of bias. In 6 studies (85.7 %), TCD was used at the time of hospital admission, on triage field in one study in the context of a confirmed AIS. A total of six TCD based biomarkers were described in the included articles, with high accuracies for LVO diagnosis (ranging from 85.9 % to 99.2 %). Pulsatility Index had the highest reported performances in terms of Accuracy for LVO diagnosis (ranging from 96 % to 99.2 %). Authors reported suboptimal temporal windows for data acquisition in 13-19.7 % of patients.
TCD is as a promising non-invasive and cost-effective tool for LVO diagnosis, presenting opportunities to enhance stroke management.
经颅多普勒（TCD）超声检查可能有助于快速诊断有急性缺血性脑卒中（AIS）临床疑似症状的患者中的大血管闭塞（LVO）。这是对 TCD 超声在诊断由 LVO 引起的 AIS 中的应用和性能的文献进行的综合回顾。
我们在 PubMed 和 Google Scholar 上进行了系统搜索，以确定报告有关 TCD 生物标志物用于 LVO 诊断和 AIS 管理数据的研究。主要关注的结局是确定的 TCD 衍生生物标志物在 LVO 诊断中的性能（特异性、敏感性、预测值）。
共筛选出 170 项研究，其中 7 项（4.1%）研究共纳入 2260 例患者（平均年龄：65.3 +/- 4.5 岁，1114 例（49.3%）为女性）。大多数研究为前瞻性（n=5，71.4%），所有研究的总体偏倚风险较低。在 6 项研究（85.7%）中，TCD 在入院时使用，在一项研究中在确认 AIS 的背景下在分诊现场使用。纳入的文章中描述了 6 种基于 TCD 的生物标志物，用于 LVO 诊断的准确率较高（范围为 85.9%至 99.2%）。脉动指数在 LVO 诊断的准确性方面表现出最高的报告性能（范围为 96%至 99.2%）。作者报告在 13-19.7%的患者中数据采集的时间窗口不理想。
TCD 是一种很有前途的非侵入性和具有成本效益的 LVO 诊断工具，为加强中风管理提供了机会。
