Saedon, Mahmud H., Dilshad, A., Tiivas, C., Virdee, D., Hutchinson, Charles E., Singer, Donald R. J. and Imray, C. (Chris) (2014) Prospective validation study of transorbital Doppler ultrasound imaging for the detection of transient cerebral microemboli. British Journal of Surgery, Volume 101 (Number 12). pp. 1551-1555. doi:10.1002/bjs.9634 ISSN 0007-1323.

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Abstract

Background:
Transient cerebral microemboli are independent biomarkers of early risk of ischaemic stroke in acute carotid syndromes. Transcranial Doppler imaging (TCD) through the temporal bone is the standard method for detection of cerebral microemboli, but an acoustic temporal bone window for TCD is not available in around one in seven patients. Transorbital Doppler imaging (TOD) has been used when TCD is not possible. The aim of this study was to validate the use of TOD against TCD for detecting cerebral microemboli.

Methods:
The study included patients undergoing elective carotid endarterectomy; all had confirmed temporal and orbital acoustic windows. Subjects gave written informed consent to postoperative TCD and TOD monitoring, which was performed simultaneously for 30 min by two vascular scientists.

Results:
The study included 100 patients (mean(s.e.m.) age 72(1) years; 65 men). Microemboli were detected by one or both methods in 40·0 per cent of patients: by TOD and TCD in 24 patients, by TOD alone in ten and by TCD alone in six. For detecting microemboli, TOD had a sensitivity of 80·0 per cent, specificity of 86·1 per cent, positive predictive value of 71·6 per cent and negative predictive value of 91·2 per cent. Bland–Altman analysis revealed no significant bias (bias 0·11 (95 per cent c.i. −0·52 to 0·74) microemboli; P = 0·810) with upper and lower limits of agreement of +6 and −6 microemboli.

Conclusion:
TOD appears a valid alternative to TCD for detecting microembolic signals in patients with no suitable temporal acoustic window.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	British Journal of Surgery
Publisher:	John Wiley & Sons Ltd.
ISSN:	0007-1323
Official Date:	November 2014
Dates:	Date Event November 2014 Published 16 September 2014 Available 25 July 2014 Accepted 24 April 2014 Submitted
Volume:	Volume 101
Number:	Number 12
Page Range:	pp. 1551-1555
DOI:	10.1002/bjs.9634
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access

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