- Jong Yun Lee, MD, PhD*,※, Sungwook Yu, MD, PhD†,※, Sung Ik Lee, MD‡, Keun Hwa Jung, MD, PhD§, Woo-Keun Seo, MD, PhD†, Jong-Moo Park, MD, PhD∥, Sun U. Kwon, MD, PhD¶, Kyung-Yul Lee, MD, PhD**, Hyo Suk Nam, MD, PhD**, Ji Man Hong, MD, PhD††, Hee-Jung Song, MD PhD‡‡, Te Gyu Lee, MD, PhD§§, Si-Ryung Han, MD, PhD∥∥, Sang-Beom Kim, MD, PhD¶¶, Yang-Ha Hwang, MD, PhD***, Eung-Gyu Kim, MD, PhD†††, Sang Won Han, MD†††, Hyung-Min Kwon, MD, PhD‡‡‡, Seung-Han Suk, MD, PhD‡, Jun Hong Lee, MD, PhD§§§, Seul-Ki Jeong, MD, PhD∥∥∥, Yong-Jae Kim, MD, PhD¶¶¶, Yong-Seok Lee, MD, PhD§
- Departments of Neurology, National Medical Center*, Korea University College of Medicine†, InAm Neuroscience Center, Sanbon Medical Center, Wonkwang University School of Medicine‡, Seoul National University College of Medicine§, Eulji University College of Medicine∥, Ulsan University College of Medicine¶, Yonsei University College of Medicine**, Ajou University College of Medicine††, Chungnam National University College of Medicine‡‡, LTG Neuromedical center§§, Catholic University College of Medicine∥∥, Kyung Hee University College of Medicine¶¶, Kyungpook National University College of Medicine***, Inje University College of Medicine†††, National Health Insurance Service Ilsan Hospital§§§, Chonbuk National University College of Medicine∥∥∥, Ewha Womans University School of Medicine¶¶¶
Transcranial Doppler ultrasound (TCD) has been widely used to assess and monitor cerebrovascular
hemodynamics. TCD has strong advantages of easy accessibility in time and space, and non-invasiveness
over other imaging techniques. However, in addition to the dependency of examiner’s
skills and experience, lack of the standardized scanning protocols is one of obstacles to overcome.
Based on the present reports and expert’s consensuses, a routine TCD evaluation should include
velocity measurement and waveform recording of the major intracranial vessels of circle of Willis and
the extracranial carotid arteries via three transcranial and one submandibular insonation. TCD examination
should contain 1) the transtemporal approach for the middle cerebral, anterior cerebral and
posterior cerebral arteries, 2) the transorbital approach for the ophthalmic artery and internal carotid
artery siphon 3) the transforaminal approach for both vertebral and basilar arteries. A routine TCD
technique in combination with headframe with dual probe fixation devices provide real-time flow
monitoring. Therefore, TCD monitoring could be used for hemodynamic change in various clinical situations. Real-time flow monitoring using TCD gives hemodynamic information to clinicians regarding
to successful recanalization in in the occluded vessel of acute ischemia, plaque stability by
detecting microemboli and collateral reservoir by vasomotor reactivity test. Beyond cerebrovascular
disease, hemodynamic information is useful in assessing brain death, subclavian steal, syncope, rotational
vertebral artery syndrome and perioperative monitoring. As TCD has expanded clinical utilities
from cerebrovascular disease to other neurological diseases for the last thirty years, standardization
of TCD protocol is essential for clinical practice as well as the future clinical studies. The
authors reviewed the present literatures and expert\\\'s consensuses, and made the current scientific
statements of TCD for proper application and interpretation.
Journal of Neurosonology 8(1):1-13, 2016
Key Words: Transcranial Doppler, Practice standards, Clinical indication, Interpretation