Sources of variability in the detection of cerebral emboli with transcranial Doppler during cardiac surgery

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
Rosendo RodriguezH J Nathan

Abstract

The application of intensity thresholds for embolus detection with transcranial Doppler (TCD) can exclude from analysis an unrecognized proportion of high-intensity transient signals (HITS))whose intensities are below the threshold. The lack of consistent threshold criteria between clinical trials may explain part of the discrepancy in the reported HITS counts. We investigated the effect of choosing different thresholds on the sensitivity and specificity of detecting HITS during cardiopulmonary bypass (CPB). Two observers independently analyzed TCD recordings from 8 patients under CPB. Doppler signals were classified as true HITS, equivocal HITS, artifacts, and Doppler speckles according to preestablished criteria. The relative intensity of Doppler signals was measured by two different methods (TCD software vs manual). Receiver Operating Characteristic curves determined the optimal threshold for each of the two intensity methods. Reviewers achieved agreement in 96% of 2190 Doppler signals (kappa = 0.90). Relative intensities calculated with the TCD-software method were 3 dB (95% CI: 3.0-3.4) higher than the manual method. The optimal threshold was found at 10 dB (sensitivity: 99%; specificity: 90.8%) with the software method an...Continue Reading

References

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Citations

Nov 13, 2013·Expert Review of Cardiovascular Therapy·Talal Al-AtassiMarc Ruel
Nov 21, 2007·The Journal of Thoracic and Cardiovascular Surgery·Munir BoodhwaniHoward J Nathan
Jul 5, 2007·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Rosendo A RodriguezHoward J Nathan
May 8, 2018·IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control·Chen BaiMingxi Wan
Aug 21, 2010·Stroke; a Journal of Cerebral Circulation·Rosendo A RodriguezHoward J Nathan
Aug 8, 2007·Journal of the Cardiometabolic Syndrome·Naftali Stern, Yonit Marcus

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