Transcranial Doppler and magnetic resonance angiography assessment of intracranial stenosis: An analysis of screening modalities

Abstract

BACKGROUND: Time-of-flight (TOF) magnetic resonance angiography (MRA) of the head and transcranial Doppler (TCD) are used to diagnose intracranial stenosis, an important cause of ischemic stroke. We aimed to compare TCD findings with TOF-MRA results in a population of patients with symptoms of cerebrovascular disease in whom both tests were done within a short intervening period of each other. METHODS: This is a retrospective, single-center study. Among adult patients referred for symptoms of cerebrovascular disease in both outpatient and inpatient settings, those who received a TCD with adequate insonation of all intracranial arteries and underwent MRA within 3 months intervals of TCD were included in this study. We evaluated the agreement between the results of these two modalities, and also assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCD through receiver-operating characteristic (ROC) curve analysis, while MRA considered as a comparator. RESULTS: Among eighty included patients, 720 arteries were examined. An overall significant agreement of 96.5% was observed between TCD and MRA (Kappa = 0.377, P < 0.001). Compared to MRA, TCD had sensitivity of 42.1%, specificity of 99.6%, PPV of 72.7%, and NPV of 98.4% (ROC area: 0.708 [0.594–0.822]). TCD is specifically accurate in evaluating middle cerebral artery (MCA) (ROC area = 0.83). CONCLUSIONS: The high NPV of TCD in our study indicates the utility of TCD as a diagnostic test to exclude the presence of intracranial stenosis. This study supports TCD as a convenient, safe, and reproducible imaging modality applicable in the screening of intracranial stenosis, especially to evaluate MCA.

Prevalence and Risk Factors Comparison of Anterior and Posterior Intracranial Arterial Stenosis

“…The application of the golden standard measurements, that is, DSA, CTA, or MRA, is not feasible in large population studies. TCD was applied to detect intracranial artery lesions in most population-based surveys in China [ 11 , 21 , 40 ], and the sensitivity was validated by a previous study [ 41 , 42 ]. With an identical criterion to define vascular lesions, our results were comparable with those of previous studies [ 11 , 21 , 40 ].…”

Application of transcranial Doppler in cerebrovascular diseases

“…Additionally, compared with the anterior circulation, there is greater tortuosity and variability in the posterior circulation; predictably, the sensitivity and specificity of TCCD are higher in the anterior circulation ( Jaiswal et al, 2019 ). A single-center retrospective study analyzed the stenosis of 720 cerebral arteries from 80 patients by TCCD and magnetic resonance angiography (MRA) ( Mowla et al, 2020 ). The results exhibited higher specificity and accuracy of TCCD than cranial MRA, confirming the suitability of TCCD for the screening of intracranial stenosis.…”