Use of a decibel threshold in detecting Doppler embolic signals

Background and Purpose To improve reproducibility and reliability in the identification of embolic signals detected with the use of Doppler ultrasound, many studies have used an intensity threshold. However, variable thresholds between 3 and 12 dB have been used, and often the method of measurement of intensity is not stated. Potentially different methods of measurement could result in different intensity measurements for the same embolic signal. We determined the effect of these differences using commercial transcranial Doppler systems. Methods We analyzed 81 embolic signals recorded from the middle cerebral arteries of patients with carotid artery disease using three different methods of measuring intensity that had been previously used in research studies. In method 1 individual lime frames of the frequency spectra were analyzed, in method 2 a color-coded intensity scale was used, and in method 3 automated software was used. Results There was a highly significant correlation between measurements made by the different techniques (method 1 versus method 2: r = .68, P < .0001; method 1 versus method 3: r = .66, P < .0001; method 2 versus method 3: r = .70: P < .0001). However, the absolute values of intensity for the same embolic signals varied markedly for the different methods. For example, a 4-dB threshold according to method 1 was equivalent to an approximately 7-dB threshold measured by method 2. These differences had major effects on the proportion of embolic signals detected with the use of the same decibel threshold but with intensity measured in the different ways. For example, using a threshold of 7 dB would result in only 4.9% of signals being missed by method 2 but 42.2% and 51.4% being missed by methods 1 and 3, respectively. Conclusions Our results demonstrate that the intensities of the same embolic signals, recorded with the same parameters, are markedly different when analyzed in the different ways used in previous studies. This has important implications when a decibel threshold is used and emphasizes that criteria developed by one investigator on one machine cannot be used by another investigator without initial reevaluation. This could account for some of the differences in frequencies of embolic signals reported in previous clinical studies.