Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion

systematic review

Daria Antipova* (Corresponding Author), Leila Eadie, Ashish MacAden, Philip Wilson

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false-negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre.

Methods: Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. MEDLINE, EMBASE, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis.

Results: Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ³21% were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68% to 100% and specificity 78% to 99% for detecting acute steno-occlusive lesions. Area under the receiver-operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however its application is largely restricted by lesion location.

Conclusions: Transcranial ultrasonography might potentially be used for the selection of subjects with acute large vessel occlusion, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.
Original languageEnglish
JournalThe Ultrasound Journal
Publication statusAccepted/In press - 3 Oct 2019

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Ultrasonography
Stroke
Thrombectomy
Cerebral Arteries
Triage
PubMed
MEDLINE
ROC Curve
Patient Selection
Libraries
Meta-Analysis
Patient Care
Emergencies
Research

Keywords

  • large vessel occlusion
  • stroke
  • acute cerebral ischaemia
  • intracerebral haemorrhage
  • transcranial ultrasonography
  • Neuroimaging

Cite this

Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion : systematic review. / Antipova, Daria (Corresponding Author); Eadie, Leila; MacAden, Ashish; Wilson, Philip.

In: The Ultrasound Journal, 03.10.2019.

Research output: Contribution to journalArticle

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title = "Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion: systematic review",
abstract = "Introduction: A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false-negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre.Methods: Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. MEDLINE, EMBASE, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis.Results: Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ³21{\%} were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68{\%} to 100{\%} and specificity 78{\%} to 99{\%} for detecting acute steno-occlusive lesions. Area under the receiver-operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however its application is largely restricted by lesion location.Conclusions: Transcranial ultrasonography might potentially be used for the selection of subjects with acute large vessel occlusion, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.",
keywords = "large vessel occlusion, stroke, acute cerebral ischaemia, intracerebral haemorrhage, transcranial ultrasonography, Neuroimaging",
author = "Daria Antipova and Leila Eadie and Ashish MacAden and Philip Wilson",
note = "Acknowledgements This work is part of a PhD project supported by the University of Aberdeen’s Elphinstone Scholarship Programme. LE’s work was funded by the European Space Agency SatCare grant. The authors would like to thank Dr Lorenzo Bandieri for the help with assessing full text of articles for eligibility for the current review.",
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T1 - Diagnostic value of transcranial ultrasonography for selecting subjects with large vessel occlusion

T2 - systematic review

AU - Antipova, Daria

AU - Eadie, Leila

AU - MacAden, Ashish

AU - Wilson, Philip

N1 - Acknowledgements This work is part of a PhD project supported by the University of Aberdeen’s Elphinstone Scholarship Programme. LE’s work was funded by the European Space Agency SatCare grant. The authors would like to thank Dr Lorenzo Bandieri for the help with assessing full text of articles for eligibility for the current review.

PY - 2019/10/3

Y1 - 2019/10/3

N2 - Introduction: A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false-negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre.Methods: Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. MEDLINE, EMBASE, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis.Results: Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ³21% were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68% to 100% and specificity 78% to 99% for detecting acute steno-occlusive lesions. Area under the receiver-operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however its application is largely restricted by lesion location.Conclusions: Transcranial ultrasonography might potentially be used for the selection of subjects with acute large vessel occlusion, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.

AB - Introduction: A number of pre-hospital clinical assessment tools have been developed to triage subjects with acute stroke due to large vessel occlusion (LVO) to a specialised endovascular centre, but their false-negative rates remain high leading to inappropriate and costly emergency transfers. Transcranial ultrasonography may represent a valuable pre-hospital tool for selecting patients with LVO who could benefit from rapid transfer to a dedicated centre.Methods: Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. MEDLINE, EMBASE, PubMed, Scopus, and The Cochrane Library were searched. Published articles reporting diagnostic accuracy of transcranial ultrasonography in comparison to a reference imaging method were selected. Studies reporting estimates of diagnostic accuracy were included in the meta-analysis.Results: Twenty-seven published articles were selected for the systematic review. Transcranial Doppler findings, such as absent or diminished blood flow signal in a major cerebral artery and asymmetry index ³21% were shown to be suggestive of LVO. It demonstrated sensitivity ranging from 68% to 100% and specificity 78% to 99% for detecting acute steno-occlusive lesions. Area under the receiver-operating characteristics curve was 0.91. Transcranial ultrasonography can also detect haemorrhagic foci, however its application is largely restricted by lesion location.Conclusions: Transcranial ultrasonography might potentially be used for the selection of subjects with acute large vessel occlusion, to help streamline patient care and allow direct transfer to specialised endovascular centres. It can also assist in detecting haemorrhagic lesions in some cases, however its applicability here is largely restricted. Additional research should optimize the scanning technique. Further work is required to demonstrate whether this diagnostic approach, possibly combined with clinical assessment, could be used at the pre-hospital stage to justify direct transfer to a regional thrombectomy centre in suitable cases.

KW - large vessel occlusion

KW - stroke

KW - acute cerebral ischaemia

KW - intracerebral haemorrhage

KW - transcranial ultrasonography

KW - Neuroimaging

M3 - Article

JO - The Ultrasound Journal

JF - The Ultrasound Journal

SN - 2524-8987

ER -