Transcranial Doppler Ultrasonography for Diagnosis of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Mean Blood Flow Velocity Ratio of the Ipsilateral and Contralateral Middle Cerebral Arteries
Transcranial Doppler Ultrasonography for Diagnosis of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Mean Blood Flow Velocity Ratio of the Ipsilateral and Contralateral Middle Cerebral Arteries
复制标题
DOI：
10.1227/neu.0b013e318222dc4c
复制
发表时间：
2011-10-01
期刊：
影响因子：
4.8
通讯作者：
Teramoto, Akira
中科院分区：
文献类型：
--
作者：
Nakae, Ryuta;Yokota, Hiroyuki;Teramoto, Akira
背景：经颅多普勒（TCD）被广泛接受用于监测蛛网膜下腔出血（SAH）后的脑血管痉挛；目的：探讨同侧大脑中动脉平均血流速度（mBFV）与对侧大脑中动脉平均血流速度（mBFV）比值（I/C mBFV）与传统绝对血流速度相比增加的预测可靠性。方法：回顾性分析7月份以来连续收治的SAH患者的临床和影像学资料。 2003年至2009年8月曾接受TCD超声检查。记录双侧大脑中动脉的最高mBFV值，而迟发性脑缺血（DCI）被定义为神经功能缺损或血管痉挛引起的脑梗塞的计算机断层扫描证据。在评估 I/C mBFV 时，将同侧定义为 mBFV 值较高的一侧。因此，我们通过与接受者操作特征 (ROC) 分析预测 DCI 的传统方法相比，阐明了该比率的可靠性。 结果：利用 1262 项 TCD 研究的具体数据对 142 名患者进行了回顾性分析。 ROC 曲线显示，使用 I/C mBFV 时 DCI 的总体预测值的曲线下面积为 0.86（95% 置信区间：0.76-0.96），而使用绝对流速时的曲线下面积为 0.80（0.71-0.88）。区分 DCI 患者和非 DCI 患者的最佳阈值是 I/C mBFV 1.5。结论：在 SAH 患者中，I/C mBFV 与血管痉挛的相关性比绝对平均流速更显着。
BACKGROUND: Transcranial Doppler (TCD) is widely accepted to monitor cerebral vasospasm after subarachnoid hemorrhage (SAH); however, its predictive value remains controversial.OBJECTIVE: To investigate the predictive reliability of an increase in the mean blood flow velocity (mBFV) ratio of the ipsilateral to contralateral middle cerebral arteries (I/C mBFV) compared with the conventional absolute flow velocity.METHODS: We retrospectively investigated the clinical and radiologic data of consecutive patients with SAH admitted from July 2003 to August 2009 who underwent TCD ultrasonography. The highest mBFV value in bilateral middle cerebral arteries was recorded, while delayed cerebral ischemia (DCI) was defined as neurological deficits or computed tomographic evidence of cerebral infarction caused by vasospasm. The ipsilateral side was defined as the side with higher mBFV value when evaluating the I/C mBFV. We thus elucidated the reliability of this rate in comparison with the conventional method for predicting DCI with receiver operating characteristic (ROC) analysis.RESULTS: One hundred and forty-two patients were retrospectively analyzed with specific data from 1262 TCD studies. The ROC curve showed that the overall predictive value for DCI had an area under the curve of 0.86 (95% confidence interval: 0.76-0.96) when the I/C mBFV was used vs 0.80 (0.71-0.88) when the absolute flow velocity was used. The threshold value that best discriminated between patients with and without DCI was I/C mBFV of 1.5.CONCLUSION: In patients with SAH, the I/C mBFV demonstrated a more significant correlation to vasospasm than the absolute mean flow velocity.