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Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

B.S. Silbert, L.A. Evered, D.A. Scott, S. Rahardja, R.P. Gerraty and P.F. Choong
American Journal of Neuroradiology October 2014, 35 (10) 1858-1863; DOI: https://doi.org/10.3174/ajnr.A3688
B.S. Silbert
aFrom the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia
bDepartment of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
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L.A. Evered
aFrom the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia
bDepartment of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
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D.A. Scott
aFrom the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia
bDepartment of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
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S. Rahardja
aFrom the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia
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R.P. Gerraty
dEpworth Healthcare (R.P.G.), Richmond, Victoria, Australia
eDepartment of Medicine (R.P.G.), Epworth HealthCare, Monash University, Melbourne, Australia.
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P.F. Choong
cDepartment of Surgery (P.F.C.), University of Melbourne, Melbourne, Australia
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    Fig 1.

    Reasons for exclusion of articles after selection.

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    Fig 2.

    The percentage of patients with emboli detected in each of the 14 studies listed in Table 3.

Tables

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    Table 1:

    Criteria for identification of high-intensity transient signals

    Criteria
    1) Doppler microembolic signal is transient, usually lasting <300 ms
    2) The amplitude is usually at least 3 dB higher than the background blood flow
    3) A signal is unidirectional within the Doppler velocity spectrum
    4) Microembolic signal is accompanied by an audible output
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    Table 2:

    Recommended parameters to be reported for transcranial Doppler ultrasound

    Parameters
    1) Ultrasound device
    2) Transducer type
    3) Insonated artery
    4) Insonation depth
    5) Algorithms for signal-intensity measurement
    6) Scale settings
    7) Detection threshold
    8) Axial extension of sample volume
    9) Fast Fourier transformation size (no. of points used)
    10) Fast Fourier transformation length (time)
    11) Fast Fourier transformation overlap
    12) Transmitted ultrasound frequency
    13) High-pass filter settings
    14) Recording time
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    Table 3:

    Studies selected for review

    Study No.Study NameYearNo. of Patients Studied
    1Forteza et al419995
    2Sulek et al20199922
    3Edmonds et al17200023
    4Rodriguez et al11200113
    5Rodriguez et al1220014
    6Riding et al15200441
    7Rodriguez et al19200537
    8Kalairajah et al18200624
    9Koch et al8200724
    10Barak et al5200822
    11Gray et al6200820
    12Gray et al22200920
    13Patel et al13200924
    14Patel et al7201045
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American Journal of Neuroradiology: 35 (10)
American Journal of Neuroradiology
Vol. 35, Issue 10
1 Oct 2014
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Cite this article
B.S. Silbert, L.A. Evered, D.A. Scott, S. Rahardja, R.P. Gerraty, P.F. Choong
Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery
American Journal of Neuroradiology Oct 2014, 35 (10) 1858-1863; DOI: 10.3174/ajnr.A3688

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Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery
B.S. Silbert, L.A. Evered, D.A. Scott, S. Rahardja, R.P. Gerraty, P.F. Choong
American Journal of Neuroradiology Oct 2014, 35 (10) 1858-1863; DOI: 10.3174/ajnr.A3688
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