Lennihan L, Petty G W, Fink M E, Solomon R A, Mohr J P
Department of Neurology, Columbia University College of Physicians and Surgeons, New York.
J Neurol Neurosurg Psychiatry. 1993 Aug;56(8):906-9. doi: 10.1136/jnnp.56.8.906.
The performance of transcranial Doppler in the detection of anterior cerebral artery vasospasm and vasospasm in patients after subarachnoid haemorrhage was analysed. Transcranial Doppler and cerebral angiography were performed within the same 24 hours on each of 41 patients with acute subarachnoid haemorrhage. Sensitivity and specificity of transcranial Doppler to classify middle cerebral arteries, anterior cerebral arteries, and patients with angiographic vasospasm were determined at mean velocities of 120 and 140 cm/s. Accuracy of transcranial Doppler was better at 140 than at 120 cm/s. For the middle cerebral artery, sensitivity was 86%, specificity 98%. For the anterior cerebral artery, sensitivity was 13%, specificity 100%. Among all patients, sensitivity was 45%, specificity 96%. Among patients with anterior communicating artery aneurysms, sensitivity was 14%, specificity 90%. Therefore, transcranial Doppler accurately differentiates between middle cerebral arteries with and without vasospasm on angiography, but has a very low sensitivity for detecting anterior cerebral artery vasospasm and vasospasm in patients with anterior communicating artery aneurysms. Since vasospasm may involve anterior cerebral arteries while sparing middle cerebral arteries, especially after rupture of an anterior communicating artery aneurysm, caution should be exercised in using negative transcranial Doppler results to make treatment decisions based on the assumed absence of vasospasm.
分析了经颅多普勒在检测蛛网膜下腔出血患者大脑前动脉血管痉挛和血管痉挛中的表现。对41例急性蛛网膜下腔出血患者在同一24小时内进行了经颅多普勒和脑血管造影检查。在平均流速为120和140厘米/秒时，确定经颅多普勒对大脑中动脉、大脑前动脉以及血管造影显示血管痉挛患者进行分类的敏感性和特异性。经颅多普勒在140厘米/秒时的准确性优于120厘米/秒。对于大脑中动脉，敏感性为86%，特异性为98%。对于大脑前动脉，敏感性为13%，特异性为100%。在所有患者中，敏感性为45%，特异性为96%。在前交通动脉瘤患者中，敏感性为14%，特异性为90%。因此，经颅多普勒能准确区分血管造影上有或无血管痉挛的大脑中动脉，但对检测大脑前动脉血管痉挛和前交通动脉瘤患者的血管痉挛敏感性非常低。由于血管痉挛可能累及大脑前动脉而不累及大脑中动脉，尤其是在前交通动脉瘤破裂后，在根据经颅多普勒阴性结果假定无血管痉挛而做出治疗决策时应谨慎。
