Comparison of Transcranial Color‐Coded Sonography and Magnetic Resonance Angiography in Acute Ischemic Stroke

Lien, Li Ming; Chen, Wei Hung; Chen, Jiunn Rong; Chiu, Hou Chang; Tsai, Yuh Feng; Choi, Wai M.; Reynolds, Patrick; Tegeler, Charles H.

doi:10.1111/j.1552-6569.2001.tb00064.x

Cited by 20 publications

(29 citation statements)

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“…Our study found a failure rate of TCCS on MCA stem insonation of 36.3%, which was below the 43.8% reported by Lien et al [9], and resembled the results obtained in other studies, which ranged from 9 to 45% [1, 5, 10, 13]. …”

Section: Discussioncontrasting

confidence: 29%

“…On TCCS, absent MCA stem signal was considered in cases where there was no MCA stem signal on the color display and no pulsed-wave Doppler signal when tracing the possible MCA stem pathway. Sonographic criteria reported in previous studies [1,2,3,4,5,6,7,8,9,10,11] were absent MCA stem signal accompanied by detectable referencing arteries (ipsilateral PCA, ipsilateral ACA or contralateral MCA stem; fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…Transcranial color-coded sonography (TCCS) is considered a reproducible and reliable method of assessing stenosis/occlusion and revascularization of the middle cerebral artery (MCA) [1,2,3,4,5,6,7,8,9,10,11]. For detecting MCA diseases, several criteria of TCCS using color flow imaging, flow velocity and flow index are reported to have high diagnostic accuracy and predictive values.…”

Section: Introductionmentioning

confidence: 99%

“…However, in patients with proximal MCA stem occlusion, TCCS cannot display the flow signal on the MCA, and thus flow velocity cannot be measured. Some authors indicate that MCA main stem can be determined to be occluded when the MCA signal is absent with an insonable ipsilateral anterior cerebral artery (ACA), ipsilateral posterior cerebral artery (PCA) or contralateral MCA on transcranial Doppler (TCD) [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28], or on TCCS [1,2,3,4,5,6,7,8,9,10,11]. However, other authors suggest that absent MCA signal may result from a small temporal window [1, 5,][10, 13, 19] and tortuous vessels rather than MCA stem occlusion.…”

Section: Introductionmentioning

confidence: 99%

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Absent Middle Cerebral Artery Signal in Transcranial Color-Coded Sonography: A Reliable Indicator of Occlusion?

Chen¹,

Chen²,

Chen³

et al. 2005

Cerebrovasc Dis

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Background: Assess the accuracy of transcranial color-coded sonography (TCCS) for detecting middle cerebral artery (MCA) stem occlusion and compare it with cerebral angiography. Methods: This study enrolled a series of patients who received TCCS and cerebral angiography at the Department of Neurology in Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, between January 1997 and July 2003. MCA stem occlusion was diagnosed based on digital subtraction angiography and/or computed tomographic angiography. The effect of the supplying artery on the insonation of MCA stem was considered. The sonographic criteria for MCA stem occlusion were defined as absent MCA stem signal + visible signal on the reference arteries, including ipsilateral posterior cerebral artery, ipsilateral anterior cerebral artery or contralateral MCA stem. Results: A total of 419 consecutive patients were enrolled. Factors that significantly influenced MCA stem insonation included ≧50% ipsilateral carotid artery stenosis, ≧50% MCA stem stenosis, female gender, and age ≧60 years. Comparing patients with <50% and those with ≧50% carotid stenosis, the MCA stem insonation rate was significantly reduced from 69.1% to 45.6% (p < 0.001). In patients with <50% ipsilateral carotid artery stenosis, the sonographic criteria had a positive predictive value of 10.5% and a negative predictive value of 98.9%, and could predict MCA stem occlusion with high specificity but low sensitivity (specificity = 89.6, sensitivity = 54.5, overall accuracy = 88.9, p < 0.001). Conclusion: Absent MCA stem signal may result from MCA stem occlusion/tight stenosis and tight stenosis of ipsilateral carotid arteries, and has a limited value in detecting MCA stem occlusion. TCCS can be useful in identifying nonoccluded MCA stem, and cerebral angiography is necessary to confirm MCA stem occlusion.

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Section: Discussioncontrasting

confidence: 29%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Absent Middle Cerebral Artery Signal in Transcranial Color-Coded Sonography: A Reliable Indicator of Occlusion?

Chen¹,

Chen²,

Chen³

et al. 2005

Cerebrovasc Dis

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“…[44][45][46] Limitations of these methods include the small risk associated with nonionizing radiation in traditional and CT angiography and limited repeatability and low sensitivity in the case of sonography. 47 DSA should play little role in modern imaging because it is invasive, exposes patients to a substantial amount of radiation, and provides no information about the cerebral parenchyma or the vessel wall. Noninvasive imaging of the MCA with MR imaging may offer benefits, including excellent spatial resolution of the vessel wall, avoiding radiation use, incorporation with stroke imaging protocols, and excellent repeatability.…”

Section: Imaging Findingsmentioning

confidence: 99%

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

Degnan

Gallagher

Zhang

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Intracranial atherosclerotic disease may constitute the most common cause of ischemic stroke worldwide; yet, in the developed world, imaging research has largely focused on extracranial atherosclerosis. Many studies in populations of Asian, African, and Hispanic descent demonstrate the preponderance of intracranial stenosis compared with carotid stenosis. This review examines the clinical presentations of MCA atherosclerosis and stenosis and the use of noninvasive MR imaging in the assessment of intracranial vasculature. MRA is a well-validated technique that offers great advantage over traditional angiography. Advances in high-resolution MR imaging of MCA stenosis have the potential to yield excellent visualization of plaque. Future developments in high-resolution MR imaging to depict intracranial atherosclerosis are explored in this review; these advances will guide endovascular therapy and the comparison of novel interventions.ABBREVIATIONS: TOF ϭ time-of-flight; TCD ϭ transcranial Doppler S troke is a common cause of morbidity and mortality, with cerebrovascular disease constituting the second most frequent cause of death worldwide.1 While the burden of cerebrovascular disease in the developing world is receiving greater attention, its importance is underestimated.2 Intracranial atherosclerotic disease is reaching greater clinical prominence as potentially the greatest contributor to the burden of cerebrovascular disease worldwide.3 Previously, atherosclerotic disease within intracranial vessels was not well-appreciated clinically, perhaps due to the inability to visualize the MCA noninvasively or the greater emphasis on the more easily imaged carotid arteries. In an early study of MCA syndromes, Lhermitte et al 4 alleged that "atherosclerotic thrombosis of MCA is probably a rare event and the primary cause . . . lies in the proximal ICA . . . for an almost inaccessible artery appears to be of little significance." Thus, early investigations established a precedent of emphasizing extracranial atherosclerosis at the expense of investigation of other manifestations of cerebrovascular disease.In examining only extracranial disease, investigators may be detecting only advanced atherosclerosis. Some argue that MCA disease may precede extracranial atherosclerosis; this sequence is suggested by the lack of substantial carotid stenosis in a group of patients with intracranial atherosclerosis, while nearly all those with extracranial stenosis also had concomitant intracranial stenosis.5 Therefore, detecting intracranial atherosclerosis may enable clinicians to intervene earlier.There is much controversy about the degree of MCA stenosis responsible for stroke, with some groups arguing that MCA stenosis is not important in the white population on the basis of a small TCD sonography study.6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke.7-9 Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic...

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Intracranial Cerebrovascular Ultrasound Examination Techniques

Alexandrov¹,

Neumyer²

2004

Cerebrovascular Ultrasound in Stroke Prevention and Treatment

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Comparison of Transcranial Color‐Coded Sonography and Magnetic Resonance Angiography in Acute Ischemic Stroke

Abstract: Elevated MCA velocities on TCCS correlate with intracranial stenosis detected on MRA. An angle-corrected peak systolic velocity > or = 120 cm/s is highly specific for detecting intracranial stenosis as defined by significant MRA abnormality.

Cited by 20 publications

References 15 publications

Absent Middle Cerebral Artery Signal in Transcranial Color-Coded Sonography: A Reliable Indicator of Occlusion?

Absent Middle Cerebral Artery Signal in Transcranial Color-Coded Sonography: A Reliable Indicator of Occlusion?

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

Intracranial Cerebrovascular Ultrasound Examination Techniques

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