Stroke, Vol 25, 1931-1934, Copyright © 1994 by American Heart Association
MB Rorick, FT Nichols and RJ Adams
BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the use
of velocity criteria applied to transcranial Doppler (TCD) signals in the
detection of stenosis of the middle cerebral (MCA), distal vertebral, and
basilar arteries. METHODS: Sixty-five patients who underwent both cerebral
angiography and transcranial Doppler examinations in the workup of acute
cerebral ischemia were reviewed. Angiography was performed a mean of 7 +/-
5 days (range, 1 to 28 days) after TCD. Interpretation of the angiogram was
performed without input regarding the TCD findings. TCD interpretation was
performed according to standard criteria. RESULTS: When we used a mean
velocity (MV) cutoff of > or = 80 cm/s in the MCA as the criterion for
stenosis, 10 of 12 stenoses of any degree were detected by TCD, with 11 of
87 false- positives. Nine of 12 MCA stem (M1) stenoses were detected when a
cutoff of > or = 90 cm/s was used, with 7 of 87 false-positives. When we
used an MV cutoff of > or = 70 cm/s as the criterion for > or = 50%
stenosis of the vertebrobasilar system, 5 of 6 stenoses were detected, with
15 of 85 false-positives. The most important confounding factor was the
presence of > or = 75% stenosis of the extracranial internal carotid
artery, resulting in both false-positive (from collateral flow) and
false-negative (decreased volume flow from the proximal stenosis without
adequate collateral flow) errors in TCD interpretation. When patients with
> or = 75% stenosis of the cervical internal carotid artery were
excluded from analysis, a TCD MV cutoff of > or = 80 cm/s identified 9
of 10 M1 lesions with 7 of 61 false-positives, and an MV of > or = 70
cm/s identified 3 of 4 vertebrobasilar lesions causing > or = 50%
stenosis with 7 of 56 false-positives. CONCLUSIONS: TCD may be an effective
screening test for M1 stenosis when velocity criteria alone are used. TCD
may less reliably detect intracranial vertebral and basilar artery
stenosis.
ARTICLES
Transcranial Doppler correlation with angiography in detection of intracranial stenosis
Department of Neurology, Case Western Reserve University, Cleveland, Ohio.
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