Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations.

Domenico Iacopino, Maria Giusa, Salvatore M. Cardali, Domenico La Torre, Sergio Baldari, Francesco Tomasello, Alfredo Conti, Alfredo Campennì, Olivia Penna, Antonella Spada

Risultato della ricerca: Article

26 Citazioni (Scopus)

Abstract

INTRODUCTION: Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS: Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow. RESULTS: The specificity of the testing was 100%, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1%. The insonation of the extracranial ICA increased sensitivity to 88% allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6%. CONCLUSIONS: The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.
Lingua originaleEnglish
pagine (da-a)326-335
Numero di pagine10
RivistaNeurocritical Care
Volume10
Stato di pubblicazionePublished - 2009

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Cerebrovascular Circulation
Doppler Transcranial Ultrasonography
Internal Carotid Artery
Brain Death
Ophthalmic Artery
Cerebral Arteries

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations. / Iacopino, Domenico; Giusa, Maria; Cardali, Salvatore M.; La Torre, Domenico; Baldari, Sergio; Tomasello, Francesco; Conti, Alfredo; Campennì, Alfredo; Penna, Olivia; Spada, Antonella.

In: Neurocritical Care, Vol. 10, 2009, pag. 326-335.

Risultato della ricerca: Article

Iacopino, Domenico ; Giusa, Maria ; Cardali, Salvatore M. ; La Torre, Domenico ; Baldari, Sergio ; Tomasello, Francesco ; Conti, Alfredo ; Campennì, Alfredo ; Penna, Olivia ; Spada, Antonella. / Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations. In: Neurocritical Care. 2009 ; Vol. 10. pagg. 326-335.
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title = "Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations.",
abstract = "INTRODUCTION: Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10{\%}. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS: Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow. RESULTS: The specificity of the testing was 100{\%}, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1{\%}. The insonation of the extracranial ICA increased sensitivity to 88{\%} allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6{\%}. CONCLUSIONS: The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.",
author = "Domenico Iacopino and Maria Giusa and Cardali, {Salvatore M.} and {La Torre}, Domenico and Sergio Baldari and Francesco Tomasello and Alfredo Conti and Alfredo Campenn{\`i} and Olivia Penna and Antonella Spada",
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T1 - Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations.

AU - Iacopino, Domenico

AU - Giusa, Maria

AU - Cardali, Salvatore M.

AU - La Torre, Domenico

AU - Baldari, Sergio

AU - Tomasello, Francesco

AU - Conti, Alfredo

AU - Campennì, Alfredo

AU - Penna, Olivia

AU - Spada, Antonella

PY - 2009

Y1 - 2009

N2 - INTRODUCTION: Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS: Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow. RESULTS: The specificity of the testing was 100%, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1%. The insonation of the extracranial ICA increased sensitivity to 88% allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6%. CONCLUSIONS: The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.

AB - INTRODUCTION: Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS: Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow. RESULTS: The specificity of the testing was 100%, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1%. The insonation of the extracranial ICA increased sensitivity to 88% allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6%. CONCLUSIONS: The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.

UR - http://hdl.handle.net/10447/57420

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JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

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