International Journal of Biomedicine. 2021;11(4):735-740.
Originally published December 10, 2021
Background: Transcranial color Doppler (TCCD) ultrasound is used to identify children with sickle cell disease (SCD) at high risk of developing stroke. There is anecdotal evidence to suggest that different ultrasound equipment can give different blood flow velocities. The purpose of this study was to compare two different TCCD ultrasound machines.
Methods and Results: A flow phantom was used to compare PSV measurements from a Philips IU-22 and Zonare Z-One ultrasound machine. Twenty-five children with SCD (aged between 2 and 16 years) attending the outpatient clinic at St. Mary’s Hospital, Imperial College Healthcare NHS Trust, as part of the NHS Sickle Cell & Thalassaemia (SC&T) screening program were studied. The two ultrasound machines compared the TAMM velocities in the middle cerebral artery and stroke risk categorization. PSV measurements using a flow phantom were underestimated by Philips IU-22 (31%) and Zonare Z-One (53%). TAMM velocities varied considerably between machines, with a poor agreement in stroke risk categorization. As a result, three children identified at increased risk of stroke by Philips IU-22 were not identified by Zonare Z-One.
Conclusion: Two ultrasound machines were found to underestimate PSV using a flow phantom. The two ultrasound machines were shown to positively correlate, and this was statistically significant. However, there was variation in the TAMM velocities recorded by the machines which resulted in the different categorization of the stroke risk of a small number of the subjects. This pilot study confirms the feasibility and clinical significance of this investigation.
- Piel FB, Steinberg MH, Rees DC. Sickle Cell Disease. N Engl J Med. 2017 Apr 20;376(16):1561-1573. doi: 10.1056/NEJMra1510865.
- Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, Wethers DL, Pegelow CH, Gill FM. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998 Jan 1;91(1):288-94.
- Adams RJ, McKie VC, Carl EM, Nichols FT, Perry R, Brock K, McKie K, Figueroa R, Litaker M, Weiner S, Brambilla D. Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler. Ann Neurol. 1997 Nov;42(5):699-704. doi: 10.1002/ana.410420505.
- Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, Abboud M, Gallagher D, Kutlar A, Nichols FT, Bonds DR, Brambilla D. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998 Jul 2;339(1):5-11. doi: 10.1056/NEJM199807023390102.
- Bernaudin F, Verlhac S, Arnaud C, Kamdem A, Chevret S, Hau I, Coïc L, Leveillé E, Lemarchand E, Lesprit E, Abadie I, Medejel N, Madhi F, Lemerle S, Biscardi S, Bardakdjian J, Galactéros F, Torres M, Kuentz M, Ferry C, Socié G, Reinert P, Delacourt C. Impact of early transcranial Doppler screening and intensive therapy on cerebral vasculopathy outcome in a newborn sickle cell anemia cohort. Blood. 2011 Jan 27;117(4):1130-40; quiz 1436. doi: 10.1182/blood-2010-06-293514.
- Cherry MG, Greenhalgh J, Osipenko L, Venkatachalam M, Boland A, Dundar Y, Marsh K, Dickson R, Rees DC. The clinical effectiveness and cost-effectiveness of primary stroke prevention in children with sickle cell disease: a systematic review and economic evaluation. Health Technol Assess. 2012;16(43):1-129. doi: 10.3310/hta16430.
- UK Forum on Haemoglobin Disorders. Transcranial Doppler Scanning for Children with Sickle Cell Disease Standards and Guidance UK2016 [06/03/2017]. Available from: http://www.haemoglobin.org.uk/wp-content/uploads/2016/10/tcdstandards.pdf.
- West Midlands Quality Review Service. Quality Standards Health Services for people with Haemoglobin Disorders UK2014. Available from: http://www.wmqrs.nhs.uk/publications.
- Jones AM, Seibert JJ, Nichols FT, Kinder DL, Cox K, Luden J, Carl EM, Brambilla D, Saccente S, Adams RJ. Comparison of transcranial color Doppler imaging (TCDI) and transcranial Doppler (TCD) in children with sickle-cell anemia. Pediatr Radiol. 2001 Jul;31(7):461-9. doi: 10.1007/s002470100427.
- Telfer P, Dwan K, Simmons A, Evanson J, Gadong N, Newell K, Tangayi S, Leigh A, Tsouana E, Hemmaway C, Kaya B. Transcranial Doppler Screening in a Regional Care Network for Sickle Cell Disease in the United Kingdom. J Pediatr Hematol Oncol. 2016 Oct;38(7):517-24. doi: 10.1097/MPH.0000000000000633.
- McCarville MB, Li C, Xiong X, Wang W. Comparison of transcranial Doppler sonography with and without imaging in the evaluation of children with sickle cell anemia. AJR Am J Roentgenol. 2004 Oct;183(4):1117-22. doi: 10.2214/ajr.183.4.1831117.
- Dunn G, Everitt B. Clinical Biosatistics: an Introduction to Evidence Based Medicine. London: Edward Arnold; 1995.
- Arkuszewski M, Krejza J, Chen R, Kwiatkowski JL, Ichord R, Zimmerman R, Ohene-Frempong K, Desiderio L, Melhem ER. Sickle cell disease: reference values and interhemispheric differences of nonimaging transcranial Doppler blood flow parameters. AJNR Am J Neuroradiol. 2011 Sep;32(8):1444-50. doi: 10.3174/ajnr.A2529.
- Pavlakis SG, Rees RC, Huang X, Brown RC, Casella JF, Iyer RV, Kalpatthi R, Luden J, Miller ST, Rogers ZR, Thornburg CD, Wang WC, Adams RJ; BABY HUG Investigators. Transcranial doppler ultrasonography (TCD) in infants with sickle cell anemia: baseline data from the BABY HUG trial. Pediatr Blood Cancer. 2010 Feb;54(2):256-9. doi: 10.1002/pbc.22282.
- Kwiatkowski JL, Yim E, Miller S, Adams RJ; STOP 2 Study Investigators. Effect of transfusion therapy on transcranial Doppler ultrasonography velocities in children with sickle cell disease. Pediatr Blood Cancer. 2011 May;56(5):777-82. doi: 10.1002/pbc.22951.
- Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003 Jul;22(1):85-93. doi: 10.1002/uog.122.
- Bulas DI, Jones A, Seibert JJ, Driscoll C, O'Donnell R, Adams RJ. Transcranial Doppler (TCD) screening for stroke prevention in sickle cell anemia: pitfalls in technique variation. Pediatr Radiol. 2000 Nov;30(11):733-8. doi: 10.1007/s002470000317.
- Krejza J, Rudzinski W, Pawlak MA, Tomaszewski M, Ichord R, Kwiatkowski J, Gor D, Melhem ER. Angle-corrected imaging transcranial doppler sonography versus imaging and nonimaging transcranial doppler sonography in children with sickle cell disease. AJNR Am J Neuroradiol. 2007 Sep;28(8):1613-8. doi: 10.3174/ajnr.A0591.
- Lui EY, Steinman AH, Cobbold RS, Johnston KW. Human factors as a source of error in peak Doppler velocity measurement. J Vasc Surg. 2005 Nov;42(5):972-9. doi: 10.1016/j.jvs.2005.07.014.
- Walker A, Olsson E, Wranne B, Ringqvist I, Ask P. Accuracy of spectral Doppler flow and tissue velocity measurements in ultrasound systems. Ultrasound Med Biol. 2004 Jan;30(1):127-32. doi: 10.1016/j.ultrasmedbio.2003.08.020.
- Browne JE. A review of Doppler ultrasound quality assurance protocols and test devices. Phys Med. 2014 Nov;30(7):742-51. doi: 10.1016/j.ejmp.2014.08.003.
- Krejza J, Swiat M, Pawlak MA, Oszkinis G, Weigele J, Hurst RW, Kasner S. Suitability of temporal bone acoustic window: conventional TCD versus transcranial color-coded duplex sonography. J Neuroimaging. 2007 Oct;17(4):311-4. doi: 10.1111/j.1552-6569.2007.00117.x.
Received September 17, 2021.
Accepted October 11, 2021.
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