• Axel Neulen, Christian Greke, Esther Prokesch, Jochem König, Daniel Wertheimer, and Alf Giese.
• Department of Neurosurgery, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany.
• Clin Neurol Neurosurg. 2013 Aug 1; 115 (8): 1382-8.

BackgroundPrinciples and accuracy of image-guided transcranial Doppler (IG TCD) sonography have been published recently. However, it remains open whether combination of image guidance and TCD offers an additional clinical advantage. This study scores the accuracy of conventional TCD examinations and investigates the potential improvement of TCD data integrity and reliability regarding the additional use of IG.MethodsConventional TCD was performed by a group of experienced investigators, who were blinded to images of a navigation system tracking the Doppler probe, whereas an independent observer documented the TCD findings, acquired by the investigators, due to saving spatial data of the TCD sample volume using IG for subsequent analysis. In a second set of experiments, image guidance was available to investigators without any previous TCD experience.ResultsThe analysis of 3D data of vessels (n=173) labeled by experienced investigators in conventional TCD, revealed a rate of 37% misinterpreted Doppler signals regarding the target vessel. Correctness of labeling was comparable between the different vascular segments. The rate of correct labeling was higher for right- (69%) than for left-sided vessels (57%). In comparison, by using IG, TCD investigators without any previous TCD experience achieved a significantly lower rate of 10% (n=39) mislabeled vessels.ConclusionsOur data suggest, that misinterpretation of the vascular source of the Doppler signal is a common source of errors in conventional TCD. Visualization of the vascular anatomy by image guidance offers improved accuracy and reliability of TCD results and may positively influence the learning curve for inexperienced investigators.Copyright © 2013. Published by Elsevier B.V.

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