Color‑coded duplex sonography vs. 3.0 Tesla magnetic resonance angiography for detection of intracranial stenosis of the internal carotid artery: A prospective cohort study

Abstract

Hemodynamic changes may provide important information for clinical decision-making in internal carotid artery (ICA) stenosis. The degree of stenosis is responsible for the hemodynamic changes. For detection of intracranial stenosis, each diagnostic method has its own advantages and disadvantages. The goal of the present study was to compare the sensitivity and accuracy of color-coded duplex sonography with that of magnetic resonance angiography (MRA) for the detection of intracranial stenosis. Patients with 3 vessels and/or left stem coronary artery disease were subjected to transcranial and extracranial color-coded duplex sonography (n=998), MRA (n=998) and invasive catheter angiography (n=939). The degree of stenosis was defined according to the Warfarin-Aspirin Symptomatic Intracranial Disease methodology. A ≥50% reduction in artery diameter was considered as a positive obstructive lesion. The benefits of each imaging method were assessed by clinical decision-making analysis. Color-coded duplex sonography and MRA, had sensitivities of 0.935 and 0.957 and accuracies of 0.92 and 0.974, respectively, when using invasive catheter angiography as a gold standard. The number of false-positive obstructive lesions detected by MRA was significantly higher than that for color-coded duplex sonography (53 vs. 13, P<0.0001). Color-coded duplex sonography was able to detect an obstructive lesion in one single image for ICAs with ≥57% stenosis, while MRA was only capable of detecting an obstructive lesion in one single image for ICAs with ≥80% stenosis. In conclusion, color-coded duplex sonography is a reliable method for the detection of intracranial stenosis in patients with coronary artery disease.

Accuracy of combined Carotid/ Transcranial color coded duplex Compared with Magnetic Resonance Angiography in the Diagnosis of Extracranial and Intracranial Artery Stenosis

“…(25) Moreover, Xiao et al, stated that Color-coded duplex sonography is a more suitable approach for the evaluation of cerebrovascular diseases than MRA. (26) Our findings contradict the results of Gujjar and co-workers that stated a poor correlation between TCD and MRA in Omani patients with acute ischemic stroke. (27) They performed TCD studies within 5 days after MRA .…”

Transcranial color‐coded ultrasound for Moyamoya disease—A holistic diagnostic tool?

“…10 TCCS has been shown previously to be comparable to digital substraction angiography and magnetic resonance angiography in detection of atherosclerotic intracranial stenosis. 11 Similar results have been shown by Wang for the use of TCCS in Moyamoya disease. 10 TCCS can also provide real time assessment of hemodynamic changes and reserve, which may be very important for selection and follow-up of revascularization candidates in Moyamoya disease.…”