Transcranial Doppler ultrasonography in cerebral arteriovenous malformations. Diagnostic sensitivity and association of flow velocity with spontaneous hemorrhage and focal neurological deficit

Abstract

Background and purpose: We sought to investigate (1) the sensitivity of transcranial Doppler ultrasonography (TCD) for diagnosis of cerebral arteriovenous malformations (AVMs) and (2) the association of feeding artery flow velocity profiles with spontaneous hemorrhage and focal neurological deficit in AVM patients.

Methods: We examined 114 consecutive AVM patients prospectively by TCD; 22 non-AVM patients with acute cerebral hemorrhage and 52 normal subjects served as controls. To estimate the association of blood flow velocity patterns in feeding arteries with spontaneous hemorrhage and focal neurological deficit, the total group of AVM subjects was divided into patients with and without a history of bleeding and also into those with and without clinical signs of "steal" (focal deficit unrelated to hemorrhage).

Results: Sensitivity for large and medium-sized AVMs was high (> 80%), whereas 62% of small AVMs were missed. TCD was also highly sensitive (80%) in a group of five AVM patients with acute hemorrhage. Flow velocity profiles were not related to spontaneous hemorrhage (mean velocity, 111 cm/s in patients with hemorrhage versus 114 cm/s in patients without hemorrhage; P = .65) or clinical signs of steal (mean velocity, 111 cm/s versus 113 cm/s in patients with and without steal, respectively; P = .89).

Conclusions: We concluded that (1) TCD is highly sensitive for large and medium-sized AVMs; (2) in acute cerebral hemorrhage TCD may help to differentiate AVM from non-AVM bleeds; (3) the predictive value of TCD findings for clinical sequelae of AVMs remains undetermined; and (4) the concept of hemodynamic steal in AVMs is not supported by TCD data.