Ultra-early evaluation of acute cerebral infarction with the combination of MRI and transcranial Doppler

Xiaoli ZHANG; Suping ZHENG; Zhengzhong MAO; Zhiwei YANG; Xiandong ZHANG; Maolin LI

ABSTRACT

BACKGROUND:

Both MRI and transcranial Doppler can be used for ultra-early assessment of acute cerebral infarction (ACI), the former is considered as a reliable diagnostic means mainly for the morphological changes of ACI, however the latter is often used before obvious morphological changes appeared, but their combined diagnostic value is still uncertain. OBJECrIVE To investigate the value of combined MRI and transcranial Doppler in ultra-early assessment of highly suspected ACI.

DESIGN:

Case analysis and double-blind design.

SETTING:

MRI Department of Daqing Oil-field General Hospital and Department of Clinical Epidemiology of West China School, and Medical-Economic Department of Public Health College, Sichuan University.

PARTICIPANTS:

From May 2000 to July 2001, totally 225 highly suspected ACI patients with stoke-like onset, 121 males and 104 females,aged of 33-86 years old with the means of (62±12), within 12 hours after onset, informed of the experiment, were selected from Daqing Oil-field General Hospital.

METHODS:

All cases subjected to transcranial Dopller examination and following MRI examination with interval of no more than 1 hour, then received follow-up MRI examination at 15 days later (as golden diagnostic standards for CI). MRI was performed to detect the position, morphology,size and signal of pathological changes. Transcranial Doppler was used to determine the blood flow velocity, peak value of systolic and diastolic stage, frequency spectrum and sound spectrum of blood flow of bilateral cerebral anterior, middle and posterior arteries, internal carotid artery and basal vertebral artery.MAIN OUTCOME

MEASURES:

The sensitivity, specificity and accuracy in the diagnosis of ACI with MRI, transcranial Doppler and the combination of MRI and transcranial Doppler.

RESULTS:

Totally 225 cases were selected, and 5 excluded for not accordant to the inclusion standards, finally 220 statistical analyzed. The diagnostic sensitivity of MRI was 79.3%,. specificity of 98.4% and accuracy of 90.5%, comparing to corresponding 80.4%, 81.3% and 80.9% of transcranial Doppler, and 96.7%, 80.5%, 87.3% of the combination of MRI and transcranial Doppler.

CONCLUSION:

The combination of MRI and transcranial Doppler can be used to make rapid and accurate assessment of ACI due to higher sensitivity and specificity.