Transcranial Doppler findings in middle cerebral arterial occlusive disease in relation to degree of stenosis and presence of concomitant stenoses

Abstract

ABSTRACT:Purpose. We evaluated the accuracy of transcranial Doppler (TCD) criteria in detecting middle cerebral artery (MCA) stenoses other than solitary severe stenoses.Methods. Three TCD criteria were evaluated in patients with acute MCA territory infarction who also underwent angiography: abnormalities in mean velocity (MV), focal areas of spectral waveform abnormalities, and compensatory increase in MV in collateral vessels.Results. Among 102 patients studied, angiography revealed MCA lesions in 48: 16 had uncomplicated lesions (single stenosis of moderate to severe degree), 19 had mildly complicated lesions (single MCA stenosis of other than moderate to severe degree, or moderate to severe MCA stenosis with a concomitant lesion outside the MCA), and 13 had severely complicated lesions (MCA stenosis of other than moderate to severe degree with a concomitant lesion outside the MCA). The sensitivity of abnormalities in MV in uncomplicated MCA lesions was 81%, whereas it was 53% in mildly complicated MCA lesions and 38% in severely complicated MCA lesions. However, a compensatory increase in MV in collaterals was more frequently found in complicated MCA lesions, and focal areas of spectral waveform abnormalities were observed fairly consistently in all groups.Conclusions. TCD findings of focal areas of spectral waveform abnormalities and compensatory collateral flow were common in complicated MCA lesions and may improve the specificity of TCD in the diagnosis of MCA stenosis.

The Accuracy of Transcranial Doppler in the Diagnosis of Middle Cerebral Artery Stenosis

“…The literature search originally identified 30 articles, 6 out of which (3 prospective and 3 retrospective) fulfilled our criteria for systematic review [12,13,14,17,18,19]. TC2-62 EME [12, 13], TC22, TC2000 [14], Multigon and Multidop [17] and Transcan EME [18, 19] were used.…”

“…Numerous articles have been published dealing with the accuracy of transcranial Doppler (TCD) in the diagnosis of a stenosis of the middle cerebral artery (MCA) [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. In these reports, different diagnostic criteria and velocity thresholds for the MCA stenosis yielded variable sensitivity and specificity parameters.…”

Collateral Circulation Imaging: MR Perfusion Territory Arterial Spin-Labeling at 3T

“…All patients were identified with evidence of Ͼ70% ICA stenosis by color-coded sonography 9 or MCA stenosis (or occlusion) by transcranial Doppler (TCD) sonography. 10 Fifty-one patients had hemispheric transient ischemic attack (n ϭ 34) or other minor deficits (n ϭ 17), including weakness on 1 side of the body, reduced vision, or dizziness within 1 month before the MR imaging examination. Five patients with unilateral asymptomatic ICA occlusion were included (3 men, 2 women).…”

Reevaluating the Transcranial Doppler Criteria for Estimation of Anterior Circulation Artery Stenosis

“…Some previous studies showed that an MFV of 80 cm/s or higher was an accurate transcranial Doppler sonographic criterion for evaluating large anterior circulation artery stenosis. [8][9][10][11][12] Other studies, however, concluded that the value of the PSV may be more accurate for assessing cerebral artery stenosis. 6,7 In this study, we found that a PSV of 120 cm/s or higher was an accurate criterion for diagnosing anterior circulation artery stenosis.…”

“…[8][9][10][11][12] There are no internationally accepted criteria for diagnosing intracranial stenosis. Furthermore, the diagnostic accuracy of predefined transcranial Doppler sonographic criteria for assessing intracranial stenosis has not yet been confirmed completely.…”