Evaluation of Transcranial Color-Coded Duplex Sonography for Cerebral Artery Stenosis or Occlusion

Abstract

Backgroundand Purpose: Cerebral artery stenosis or occlusion is the most common etiological factor in patients with acute cerebral ischemia, but the rate of early diagnosis is low. The purpose of the study is to evaluate the diagnostic accuracy of transcranial color-coded sonography (TCCS) for cerebral artery stenosis with digital subtraction angiography used as the gold standard of reference. Methods: Seventy-eight patients who were suspected of cerebrovascular disease were involved in the study. Major cerebral arteries were observed through the transcranial echo window by TCCS. The course, shape of the color blood beam and velocity were given special attention. The hemodynamic parameter was measured and analyzed. The findings of TCCS were compared with the results of digital subtraction angiography, according to a double-blind design. A 4-fold table was used as the statistical analysis method to evaluate TCCS. The indexes included sensitivity, specificity, accuracy and false-positive rate. Results: Imaging of TCCS revealed that the blood flow beam narrowed where the artery had stenosis and looked like girdling. The velocity of the foci increased abnormally, while the velocity before and after the foci decreased. Severe stenosis and the long stenotic segment may show discontinuity of the blood flow beam. The velocity of the foci did not noticeably increase or decrease. The blood flow beam of the occlusive artery cannot be seen and the frequency spectrum cannot be obtained, but the other artery was well visualized at the same time. Analysis of the diagnostic value of TCCS according to the 4-fold table included the validity index, with a sensitivity, specificity, false-positive rate, false-negative rate, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and Youden index of 72.9%, 82.9%, 17.1%, 27.0%, 78.2%, 79.4%, 77.3%, 4.3, 0.3 and 0.56, respectively. The reliability index included the agreement rate and κ value, which were 78.2% and 0.56, respectively. Conclusions: TCCS could be considered a valuable method for the screening diagnosis of cerebral artery stenosis or occlusion.

Detection of Intracranial Arterial Stenosis Using Transcranial Color-Coded Duplex Sonography, Computed Tomographic Angiography, and Digital Subtraction Angiography

“…In previous studies, 2 diagnostic methods (transcranial color-coded sonography versus digital subtraction angiography, CT angiography versus digital subtraction angiography, or magnetic resonance angiography versus digital subtraction angiography) were usually compared. [4][5][6] For example, Klötzsch et al 5 compared the findings in intracranial vessels acquired using transcranial color-coded sonography and digital subtraction angiography in 40 pa-tients and obtained values similar to those in this study (94.2% of displayed vessels; κ = 0.628). Hou et al 4 found a slightly lower correlation between transcranial colorcoded sonography and digital subtraction angiography (κ = 0.56), with sensitivity, specificity, PPV, and NPV values of 72.9%, 82.9%, 78.2%, and 79.4%, respectively.…”

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tenosis and occlusion represent the most frequent abnormalities detected in intracranial arteries. [1][2][3][4][5][6][7][8] Stenosis of an intracranial artery is caused by an atherosclerotic plaque in more than 90% of cases and by a vasospasm, dissection, or vasculitis in less than 10%. Intracranial artery stenosis of atherosclerotic origin is a risk factor for ischemic stroke, [9][10][11] and acute occlusion of intracranial vessels due to atherosclerosis or thrombembolism is the most common cause of stroke.

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Primary angiitis of the central nervous system: diagnosis and treatment

“… 54 Colour duplex sonography might be useful for follow-up examinations in patients with cerebral artery stenoses. 113 …”

Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

“…Transcranial color-coded duplex sonography (TCCS) is widely used to evaluate the intracranial arterial system in patients with acute stroke [1,2,3,4]. There have been insufficient data to compare the ability of ultrasonographic examination to visualize intracranial structures and vessels through the skull bone in different races [5,6,7].…”