Diagnostic significance of transcranial Doppler ultrasonography in patients with subarachnoid hemorrhage and cerebral vasospasm

Abstract

Background This study investigated the accuracy and usefulness of transcranial Doppler (TCD) ultrasonography as a diagnostic method in patients with subarachnoid hemorrhage (SAH) and cerebral vasospasm. Methods This retrospective study collected data from January 2022 to December 2023 at our institution, targeting patients with SAH caused by rupture of a cerebral aneurysm. TCD and brain computed tomographic angiography (CTA) were performed to diagnose cerebral vasospasm. The vessel diameters on CTA at the time of SAH occurrence and CTA 1 to 2 weeks after the occurrence were compared, and TCD was performed on a daily basis from 3 to 14 days after the occurrence of ictus. Results Among 152 patients with non-traumatic SAH over a 2-year period, 143 patients with SAH caused by ruptured cerebral aneurysms were enrolled. The mean age was 59.28±13.27 years. The modified Fisher grade was a statistically significant predictor of cerebral vasospasm (p<0.05). In addition, the Hunt-Hess grade also showed statistical significance (p<0.05). TCD showed high accuracy in predicting vasospasm. The sensitivity was 0.93 (95% confidence interval [CI], 0.87–0.97), specificity was 0.89 (95% CI, 0.81–0.96), positive predictive value was 0.91 (95% CI, 0.85–0.96), and negative predictive value was 0.91 (95% CI, 0.84–0.95). Conclusions TCD showed high accuracy in predicting the diagnosis of cerebral vasospasm. TCD is considered an essential diagnostic tool in the neurological management of cerebral vasospasm, which is a potentially fatal complication in SAH patients.

Keywords

• subarachnoid hemorrhage
• ultrasonography, doppler, transcranial
• vasospasm, intracranial