Subscribe to RSS
DOI: 10.1055/s-0032-1331812
Transcranial Doppler Ultrasound: Technique and Application
Publication History
Publication Date:
29 January 2013 (online)
Abstract
Transcranial Doppler (TCD) ultrasound provides rapid, noninvasive, real-time measures of cerebrovascular function. TCD can be used to measure flow velocity in the basal arteries of the brain to assess relative changes in flow, diagnose focal vascular stenosis, or to detect embolic signals within these arteries. TCD can also be used to assess the physiologic health of a particular vascular territory by measuring blood flow responses to changes in blood pressure (cerebral autoregulation), changes in end-tidal CO2 (cerebral vasoreactivity), or cognitive and motor activation (neurovascular coupling or functional hyperemia). TCD has established utility in the clinical diagnosis of a number of cerebrovascular disorders such as acute ischemic stroke, vasospasm, subarachnoid hemorrhage, sickle cell disease, as well as other conditions such as brain death. Clinical indication and research applications for this mode of imaging continue to expand. In this review, the authors summarize the basic principles and clinical utility of TCD and provide an overview of a few TCD research applications.
-
References
- 1 Aaslid R. Transcranial Doppler Sonography. New York: Springer-Verlag; 1986
- 2 DeWitt LD, Wechsler LR. Transcranial Doppler. Stroke 1988; 19 (7) 915-921
- 3 Tegeler CH, Ratanakorn D. Physics and principles. In: Babikian VL, Wechsler LR, , eds. Transcranial Doppler Ultrasonography. Second ed. Waltham, MA: Butterworth-Heinemann; 1999: 3-11
- 4 Bishop CC, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 1986; 17 (5) 913-915
- 5 Nuttall GA, Cook DJ, Fulgham JR, Oliver Jr WC, Proper JA. The relationship between cerebral blood flow and transcranial Doppler blood flow velocity during hypothermic cardiopulmonary bypass in adults. Anesth Analg 1996; 82 (6) 1146-1151
- 6 Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke 2000; 31 (7) 1672-1678
- 7 Vriens EM, Kraaier V, Musbach M, Wieneke GH, van Huffelen AC. Transcranial pulsed Doppler measurements of blood velocity in the middle cerebral artery: reference values at rest and during hyperventilation in healthy volunteers in relation to age and sex. Ultrasound Med Biol 1989; 15 (1) 1-8
- 8 Arnolds BJ, von Reutern GM. Transcranial Doppler sonography. Examination technique and normal reference values. Ultrasound Med Biol 1986; 12 (2) 115-123
- 9 Grolimund P, Seiler RW. Age dependence of the flow velocity in the basal cerebral arteries—a transcranial Doppler ultrasound study. Ultrasound Med Biol 1988; 14 (3) 191-198
- 10 Babikian V, Wechsler L , eds. Transcranial Doppler Ultrasonography. 2nd ed. Waltham, MA: Butterworth Heinmann; 1999
- 11 Macko RF, Ameriso SF, Akmal M , et al. Arterial oxygen content and age are determinants of middle cerebral artery blood flow velocity. Stroke 1993; 24 (7) 1025-1028
- 12 Ameriso SF, Paganini-Hill A, Meiselman HJ, Fisher M. Correlates of middle cerebral artery blood velocity in the elderly. Stroke 1990; 21 (11) 1579-1583
- 13 Brass LM, Pavlakis SG, DeVivo D, Piomelli S, Mohr JP. Transcranial Doppler measurements of the middle cerebral artery. Effect of hematocrit. Stroke 1988; 19 (12) 1466-1469
- 14 Fiermonte G, Aloe Spiriti MA, Latagliata R, Petti MC, Giacomini P. Polycythaemia vera and cerebral blood flow: a preliminary study with transcranial Doppler. J Intern Med 1993; 234 (6) 599-602
- 15 Fullerton HJ, Adams RJ, Zhao S, Johnston SC. Declining stroke rates in Californian children with sickle cell disease. Blood 2004; 104 (2) 336-339
- 16 Poulin MJ, Liang PJ, Robbins PA. Dynamics of the cerebral blood flow response to step changes in end-tidal PCO2 and PO2 in humans. J Appl Physiol 1996; 81 (3) 1084-1095
- 17 Tzeng YC, Willie CK, Atkinson G, Lucas SJ, Wong A, Ainslie PN. Cerebrovascular regulation during transient hypotension and hypertension in humans. Hypertension 2010; 56 (2) 268-273
- 18 Doering TJ, Brix J, Schneider B, Rimpler M. Cerebral hemodynamics and cerebral metabolism during cold and warm stress. Am J Phys Med Rehabil 1996; 75 (6) 408-415
- 19 Bisschops LL, van der Hoeven JG, Hoedemaekers CW. Effects of prolonged mild hypothermia on cerebral blood flow after cardiac arrest. Crit Care Med 2012; 40 (8) 2362-2367
- 20 Lupetin AR, Davis DA, Beckman I, Dash N. Transcranial Doppler sonography. Part 1. Principles, technique, and normal appearances. Radiographics 1995; 15 (1) 179-191
- 21 Martin PJ, Evans DH, Naylor AR. Measurement of blood flow velocity in the basal cerebral circulation: advantages of transcranial color-coded sonography over conventional transcranial Doppler. J Clin Ultrasound 1995; 23 (1) 21-26
- 22 Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57 (6) 769-774
- 23 Arnolds BJ, von Reutern GM. Transcranial Doppler sonography. Examination technique and normal reference values. Ultrasound Med Biol 1986; 12 (2) 115-123
- 24 Hennerici M, Rautenberg W, Sitzer G, Schwartz A. Transcranial Doppler ultrasound for the assessment of intracranial arterial flow velocity—Part 1. Examination technique and normal values. Surg Neurol 1987; 27 (5) 439-448
- 25 Spencer MP, Whisler D. Transorbital Doppler diagnosis of intracranial arterial stenosis. Stroke 1986; 17 (5) 916-921
- 26 Alexandrov AV, Sloan MA, Wong LK , et al; American Society of Neuroimaging Practice Guidelines Committee. Practice standards for transcranial Doppler ultrasound: part I—test performance. J Neuroimaging 2007; 17 (1) 11-18
- 27 Tegeler CH, Babikian VL, Gomes CR , eds. Neurosonology. St. Louis, MO: Mosby-Year Book; 1996
- 28 Ringelstein EB, Kahlscheuer B, Niggemeyer E, Otis SM. Transcranial Doppler sonography: anatomical landmarks and normal velocity values. Ultrasound Med Biol 1990; 16 (8) 745-761
- 29 Fish P. Physics and Instrumentation of Diagnostic Medical Ultrasound. Hoboken, NJ: Wiley; 1990
- 30 Verlhac S. Transcranial Doppler in children. Pediatr Radiol 2011; 41 (Suppl. 01) S153-S165
- 31 Sloan MA, Alexandrov AV, Tegeler CH , et al; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004; 62 (9) 1468-1481
- 32 Lysakowski C, Walder B, Costanza MC, Tramèr MR. Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: A systematic review. Stroke 2001; 32 (10) 2292-2298
- 33 Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989; 100 (1-2) 12-24
- 34 Tsivgoulis G, Alexandrov AV, Sloan MA. Advances in transcranial Doppler ultrasonography. Curr Neurol Neurosci Rep 2009; 9 (1) 46-54
- 35 Saqqur M, Zygun D, Demchuk A. Role of transcranial Doppler in neurocritical care. Crit Care Med 2007; 35 (5, Suppl) S216-S223
- 36 Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995; 26 (1) 14-20
- 37 Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B. Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996; 27 (11) 1974-1980
- 38 Babikian VL, Feldmann E, Wechsler LR , et al. Transcranial Doppler ultrasonography: year 2000 update. J Neuroimaging 2000; 10 (2) 101-115
- 39 Rasulo FA, De Peri E, Lavinio A. Transcranial Doppler ultrasonography in intensive care. Eur J Anaesthesiol Suppl 2008; 42 (42) 167-173
- 40 Camerlingo M, Casto L, Censori B, Ferraro B, Gazzaniga GC, Mamoli A. Transcranial Doppler in acute ischemic stroke of the middle cerebral artery territories. Acta Neurol Scand 1993; 88 (2) 108-111
- 41 Zanette EM, Fieschi C, Bozzao L , et al. Comparison of cerebral angiography and transcranial Doppler sonography in acute stroke. Stroke 1989; 20 (7) 899-903
- 42 Baumgartner RW, Mattle HP, Schroth G. Assessment of >/= 50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 1999; 30 (1) 87-92
- 43 Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L. Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 1989; 91 (3) 311-321
- 44 Demchuk AM, Christou I, Wein TH , et al. Accuracy and criteria for localizing arterial occlusion with transcranial Doppler. J Neuroimaging 2000; 10 (1) 1-12
- 45 Eggers J, Koch B, Meyer K, König I, Seidel G. Effect of ultrasound on thrombolysis of middle cerebral artery occlusion. Ann Neurol 2003; 53 (6) 797-800
- 46 Alexandrov AV. Ultrasound enhancement of fibrinolysis. Stroke 2009; 40 (3 Suppl) S107-S110
- 47 Bor-Seng-Shu E, Nogueira RdeC, Figueiredo EG, Evaristo EF, Conforto AB, Teixeira MJ. Sonothrombolysis for acute ischemic stroke: a systematic review of randomized controlled trials. Neurosurg Focus 2012; 32 (1) E5
- 48 Camerlingo M, Casto L, Censori B, Servalli MC, Ferraro B, Mamoli A. Prognostic use of ultrasonography in acute non-hemorrhagic carotid stroke. Ital J Neurol Sci 1996; 17 (3) 215-218
- 49 Baracchini C, Manara R, Ermani M, Meneghetti G. The quest for early predictors of stroke evolution: can TCD be a guiding light?. Stroke 2000; 31 (12) 2942-2947
- 50 Kushner MJ, Zanette EM, Bastianello S , et al. Transcranial Doppler in acute hemispheric brain infarction. Neurology 1991; 41 (1) 109-113
- 51 Toni D, Fiorelli M, Zanette EM , et al. Early spontaneous improvement and deterioration of ischemic stroke patients. A serial study with transcranial Doppler ultrasonography. Stroke 1998; 29 (6) 1144-1148
- 52 Molina CA, Montaner J, Abilleira S , et al. Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke. Stroke 2001; 32 (5) 1079-1084
- 53 Wijnhoud AD, Koudstaal PJ, Dippel DW. The prognostic value of pulsatility index, flow velocity, and their ratio, measured with TCD ultrasound, in patients with a recent TIA or ischemic stroke. Acta Neurol Scand 2011; 124 (4) 238-244
- 54 Derdeyn CP, Khosla A, Videen TO , et al. Severe hemodynamic impairment and border zone—region infarction. Radiology 2001; 220 (1) 195-201
- 55 Bozzao L, Fantozzi LM, Bastianello S, Bozzao A, Fieschi C. Early collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion. Stroke 1989; 20 (6) 735-740
- 56 Molina CA, Alexandrov AV, Demchuk AM, Saqqur M, Uchino K, Alvarez-Sabín J. CLOTBUST Investigators. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 2004; 35 (1) 151-156
- 57 Kucinski T, Koch C, Eckert B , et al. Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke. Neuroradiology 2003; 45 (1) 11-18
- 58 Jordan LC, Casella JF, Debaun MR. Prospects for primary stroke prevention in children with sickle cell anaemia. Br J Haematol 2012; (Jan) 9
- 59 Adams RJ, Brambilla D. Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators. Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease. N Engl J Med 2005; 353 (26) 2769-2778
- 60 Enninful-Eghan H, Moore RH, Ichord R, Smith-Whitley K, Kwiatkowski JL. Transcranial Doppler ultrasonography and prophylactic transfusion program is effective in preventing overt stroke in children with sickle cell disease. J Pediatr 2010; 157 (3) 479-484
- 61 Markus H, Pereira A, Cloud G. Stroke Medicine. 1st ed. New York: Oxford University Press; 2010
- 62 Molloy J, Markus HS. Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke 1999; 30 (7) 1440-1443
- 63 Markus HS, MacKinnon A. Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke 2005; 36 (5) 971-975
- 64 Markus HS, Droste DW, Kaps M , et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111 (17) 2233-2240
- 65 Markus HS, King A, Shipley M , et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 2010; 9 (7) 663-671
- 66 Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363 (9413) 915-924
- 67 Aaslid R, Lindegaard KF, Sorteberg W, Nornes H. Cerebral autoregulation dynamics in humans. Stroke 1989; 20 (1) 45-52
- 68 Hamner JW, Cohen MA, Mukai S, Lipsitz LA, Taylor JA. Spectral indices of human cerebral blood flow control: responses to augmented blood pressure oscillations. J Physiol 2004; 559 (Pt 3) 965-973
- 69 Panerai RB. Transcranial Doppler for evaluation of cerebral autoregulation. Clin Auton Res 2009; 19 (4) 197-211
- 70 Willie CK, Colino FL, Bailey DM , et al. Utility of transcranial Doppler ultrasound for the integrative assessment of cerebrovascular function. J Neurosci Methods 2011; 196 (2) 221-237
- 71 Markus HS, Harrison MJ. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke 1992; 23 (5) 668-673
- 72 Mancini M, De Chiara S, Postiglione A, Ferrara LA. Transcranial Doppler evaluation of cerebrovascular reactivity to acetazolamide in normal subjects. Artery 1993; 20 (4) 231-241
- 73 Serrador JM, Sorond FA, Vyas M, Gagnon M, Iloputaife ID, Lipsitz LA. Cerebral pressure-flow relations in hypertensive elderly humans: transfer gain in different frequency domains. J Appl Physiol 2005; 98 (1) 151-159
- 74 Sorond FA, Lipsitz LA. Aging and the cerebral microvasculature: clinical implications and potential therapeutic interventions. In: Masoro E, Austad S, , eds. Handbook on the Biology of Aging. 7th ed. London: Academic Press; 2011: 347-371
- 75 Kelley RE, Chang JY, Suzuki S, Levin BE, Reyes-Iglesias Y. Selective increase in the right hemisphere transcranial Doppler velocity during a spatial task. Cortex 1993; 29 (1) 45-52
- 76 Girouard H, Iadecola C. Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol 2006; 100 (1) 328-335
- 77 Udomphorn Y, Armstead WM, Vavilala MS. Cerebral blood flow and autoregulation after pediatric traumatic brain injury. Pediatr Neurol 2008; 38 (4) 225-234
- 78 Chan KH, Miller JD, Dearden NM. Intracranial blood flow velocity after head injury: relationship to severity of injury, time, neurological status and outcome. J Neurol Neurosurg Psychiatry 1992; 55 (9) 787-791
- 79 Trabold F, Meyer PG, Blanot S, Carli PA, Orliaguet GA. The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 2004; 30 (1) 108-112
- 80 Ract C, Le Moigno S, Bruder N, Vigué B. Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med 2007; 33 (4) 645-651
- 81 Rudolph JL, Sorond FA, Pochay VE , et al. Cerebral hemodynamics during coronary artery bypass graft surgery: the effect of carotid stenosis. Ultrasound Med Biol 2009; 35 (8) 1235-1241
- 82 Halsey JH, McDowell HA, Gelmon S, Morawetz RB. Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy. Stroke 1989; 20 (1) 53-58
- 83 Halsey JH, McDowell HA, Gelman S. Transcranial Doppler and rCBF compared in carotid endarterectomy. Stroke 1986; 17 (6) 1206-1208
- 84 Keage HA, Churches OF, Kohler M , et al. Cerebrovascular function in aging and dementia: a systematic review of transcranial Doppler studies. Dement Geriatr Cogn Dis Extra 2012; 2 (1) 258-270
- 85 Sabayan B, Jansen S, Oleksik AM , et al. Cerebrovascular hemodynamics in Alzheimer's disease and vascular dementia: a meta-analysis of transcranial Doppler studies. Ageing Res Rev 2012; 11 (2) 271-277
- 86 Purandare N, Burns A, Morris J, Perry EP, Wren J, McCollum C. Association of cerebral emboli with accelerated cognitive deterioration in Alzheimer's disease and vascular dementia. Am J Psychiatry 2012; 169 (3) 300-308