Sensitivity and specificity of transcranial Doppler ultrasonography in the detection of high-grade carotid stenosis
Kelley, R.E.; Namon, R.A.; Mantelle, L.L.; Chang, J.Y.
Neurology 43(6): 1187-1191
1993
ISSN/ISBN: 0028-3878 PMID: 7909589 Document Number: 420237
We evaluated the ability of transcranial Doppler ultrasonography (TCD) of the middle cerebral artery to detect internal carotid artery luminal area stenosis of 70% or greater by comparing TCD with cerebral angiography in 79 subjects, including 22 with normal cerebral arteriograms and 57 with 30% to 100% internal carotid artery stenosis on at least one side. Of six TCD measurements assessed, the flow acceleration provided the greatest sensitivity (82%) and specificity (73%) in distinguishing 70% to 100% carotid stenosis from lesser degrees of stenosis. The overall accuracy of the flow acceleration was 78%, and the positive predictive value was 79%. A flow acceleration of 351.6 cm/sec-2 or less was useful for detecting high-grade stenosis, but there was difficulty in distinguishing unilateral from bilateral high-grade stenosis. TCD measurement of the flow acceleration allows for fairly reliable detection of high-grade stenosis and can thus serve as a useful indirect component of a carotid noninvasive battery.