Sloan M A, Burch C M, Wozniak M A, Rothman M I, Rigamonti D, Permutt T, Numaguchi Y
Department of Neurology, University of Maryland School of Medicine, Baltimore.
Stroke. 1994 Nov;25(11):2187-97. doi: 10.1161/01.str.25.11.2187.
Transcranial Doppler sonography is of established value in the detection and monitoring of middle cerebral artery vasospasm. Little information exists on the utility of transcranial Doppler for detection of posterior circulation vasospasm.
Cerebral angiography and conventional hand-held transcranial Doppler sonography were compared to determine sensitivity and specificity of transcranial Doppler for detection of vertebral and basilar artery vasospasm.
Of 59 consecutive subarachnoid hemorrhage patients with transcranial Doppler angiogram correlations, 42 underwent posterior circulation angiography to evaluate 64 vertebral arteries and 42 basilar arteries during the period of risk for vasospasm and had technically adequate transcranial Doppler examinations within 24 hours of the angiogram. A mean flow velocity of 60 cm/s and above was indicative of both vertebral and basilar artery vasospasm. For the vertebral artery, there were 7 true-positive test results, 42 true-negatives, 6 false-positives (unknown cause in 3, increased collateral flow in 1, adjacent vessel vasospasm in 1, hyperperfusion in 1), and 9 false-negatives (anatomic in 7, operator error in 2). Sensitivity was 44% and specificity was 87.5%. For the basilar artery, there were 10 true-positives, 23 true-negatives, 6 false-positives (unknown cause in 4, hyperemia/hyperperfusion in 1, increased collateral flow in 1), and 3 false-negatives (operator error in 2, tortuous vessel course in 1). Sensitivity was 76.9% and specificity was 79.3%. When the diagnostic criterion was changed to > or = 80 cm/s (vertebral artery) and > or = 95 cm/s (basilar artery), all false-positive results were eliminated (specificity and positive predictive value, 100%).
Our data suggest that transcranial Doppler has good specificity for the detection of vertebral artery vasospasm and good sensitivity and specificity for the detection of basilar artery vasospasm. Transcranial Doppler is highly specific (100%) for vertebral and basilar artery vasospasm when flow velocities are > or = 80 and > or = 95 cm/s, respectively.
经颅多普勒超声在检测和监测大脑中动脉血管痉挛方面具有既定价值。关于经颅多普勒用于检测后循环血管痉挛的效用，现有信息较少。
比较脑血管造影和传统手持式经颅多普勒超声，以确定经颅多普勒检测椎动脉和基底动脉血管痉挛的敏感性和特异性。
在59例连续的蛛网膜下腔出血患者中，经颅多普勒血管造影相关，42例患者在血管痉挛风险期接受了后循环血管造影，以评估64条椎动脉和42条基底动脉，并在血管造影后24小时内进行了技术上足够的经颅多普勒检查。平均流速60厘米/秒及以上表明椎动脉和基底动脉均有血管痉挛。对于椎动脉，有7例假阳性检测结果，42例假阴性，6例假阳性（3例原因不明，1例侧支血流增加，1例相邻血管痉挛，1例血流灌注过多），9例假阴性（7例解剖学原因，2例操作失误）。敏感性为44%，特异性为87.5%。对于基底动脉，有10例假阳性，23例假阴性，6例假阳性（4例原因不明，1例充血/血流灌注过多，1例侧支血流增加），3例假阴性（2例操作失误，1例血管走行迂曲）。敏感性为76.9%，特异性为79.3%。当诊断标准改为椎动脉≥80厘米/秒和基底动脉≥95厘米/秒时，所有假阳性结果均被消除（特异性和阳性预测值为100%）。
我们的数据表明，经颅多普勒对检测椎动脉血管痉挛具有良好的特异性，对检测基底动脉血管痉挛具有良好的敏感性和特异性。当流速分别≥80厘米/秒和≥95厘米/秒时，经颅多普勒对椎动脉和基底动脉血管痉挛具有高度特异性（100%）。
