Transcranial Color-Coded Duplex Sonography and Digital Subtraction Angiography in Acute Stroke Patients

Abstract

Background: Stroke is the most common neurological disorder with a high incidence in Middle-eastern regions. We aimed to assess the diagnostic accuracy of transcranial color-coded duplex sonography (TCCS) for detection of cerebral artery stenosis compared to digital subtraction angiography (DSA) as a gold standard method.Methods: Eighty patients presenting with symptoms of cerebral ischemia were enrolled in the study. They were examined by color-coded Doppler and TCCS to determine stenosis of extracranial and intracranial arteries, respectively. DSA was performed 24-48 hours after the initial examination. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of TCCS in comparison to DSA was calculated. The agreement between the two methods was determined by kappa statistics. Results: Eighty patients (60% male, 40% female) with a mean age of 61.32±12.6 years were included. In 65% of cases, pathology in carotid artery was responsible for ischemia. We did not observe any abnormalities in the anterior cerebral artery (ACA), posterior cerebral artery (PCA) as well as basilar artery (BA). The agreement between TCCS and DSA in various arterial vessels were 0.9 for common carotid artery (CCA), 0.86 for internal carotid artery (ICA), 0.78 for middle cerebral artery (MCA), and 0.86 for vertebral artery (VA). The sensitivity, specificity, PPV, NPV, accuracy, and kappa value of TCCS for detection of stenosis regarding the arterial segments were 84.8%, 81%, 92.6%, 65.4%, 83.8, and 0.71, respectively. Conclusion: TCCS is a valuable, non-invasive, and repeatable method to investigate cerebral artery stenosis with high diagnostic accuracy.