Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients

Abstract

Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10–1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06–1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60–0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.

Peripheral Vascular Resistance in Cerebral Arteries in Patients With Carotid Atherosclerosis – Substudy Results of the Atherosclerotic Plaque Characteristics Associated With a Progression Rate of the Plaque and a Risk of Stroke in Patients With the Carotid Bifurcation Plaque Study (ANTIQUE)

“…14,37,38 Microangiopathy, including impairment of cerebral vessels, is a frequent complication of DM. 7,8,39 Lee et al 39 showed that PI in the MCA was significantly higher in DM patients with complications than in those without complications and in healthy controls, and is closely correlated with the duration of DM. Hemodynamic changes are observed not only in type 2, but also in type 1 DM, and are also enhanced in the long-term diabetes group.…”

“…Small vessel disease (SVD) belongs to the relatively frequent disorders influencing the RI a PI in the cerebral arteries. 8 SVD is a disorder of the brain's small perforating arterioles, capillaries, and probably venules that causes various brain lesions detected using brain magnetic resonance or computed tomography. 9,10 Typical lesions are white matter hyperintensities of presumed vascular origin, lacunes, microbleeds, superficial siderosis, perivascular spaces, and microinfarcts.…”

Cerebral Vasoreactivity Changes Over Time in Patients With Different Clinical Manifestations of Cerebral Small Vessel Disease

“…Though no direct anatomical information can be obtained, TCD permits for the evaluation of mean flow velocity (MFV) changes in the major cerebral arteries after a vasodilative stimulus and it provides complementary information of the brain hemodynamics (Ringelstein et al, 1988;Ebrahim et al, 2019;Burley et al, 2021a). The results of the TCD examination (MFV and pulsatility index) and the ventilation tests correlate with those obtained by other methods, and the value of TCD in the evaluation of CVR impairment, e.g., in the asymptomatic or symptomatic individuals with the brain white matter lesions (WMLs) has been established (Maeda et al, 1993;Marcos et al, 1997;Ghorbani et al, 2015;Fu et al, 2019). The assessment of CVR can be achieved with the bilateral recording of MFV in the middle cerebral artery (MCA) with acceptable reproducibility and inter-rater reliability using carbogen inhalation (McDonnell et al, 2013).…”

White matter hyperintensities and the pulsatility index: fellow travelers or partners in crime?

“…In this issue of Arquivos de Neuro-Psiquiatria, Fu et al 23 report on an evaluation of 184 elderly patients with cerebral small vessel disease as shown by transcranial Doppler and MRI 23 . They observed that the elevated pulsatility index obtained in the middle cerebral artery was significantly correlated with severe WMHs, using the Fazekas scale.…”

“…In addition, the pulsatility index described in most scientific papers should be cited as the Gosling pulsatility index 25 . Another important consideration is related to the ethnic group in the study by Fu et al 23 . Cerebral blood flow velocities and pulsatility index patterns may be affected by ethnicity not only during the examination, with respect to the temporal window, but also by the predominance of specific vascular diseases.…”