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Journal of Ultrasound in Medicine, Vol 7, Issue 11 611-616, Copyright © 1988 by American Institute of Ultrasound in Medicine
Transcranial Doppler evaluation of middle cerebral artery stenosis
J. M. de Bray, P. A. Joseph, H. Jeanvoine, D. Maugin, M. Dauzat and F. Plassard
Department of Neurology B, Centre Hospitalier Regional, Angers, France.
Symptomatic stenoses of the middle cerebral artery (MCA) are not uncommon,
although Corston observed the occurrence of stroke in 24% of patients with
MCA stenoses during a 6-year follow-up study. We tried to use transcranial
Doppler (TCD) sonography for the detection and evaluation of MCA stenoses.
Intra-arterial angiography demonstrated 16 MCA stenoses of more than 30%
diameter reduction in 15 patients (14 atheromatous stenoses, 2 dysplasias).
Severe associated lesions were present in 2 cases (more than 75% internal
carotid artery stenosis). These 15 patients with MCA stenosis were examined
with TCD in a blind study. A Doppler signal from the MCA was obtained
through the temporal bone and was recognized on the result of common
carotid artery compression test. We ascertained MCA stenosis when TCD
demonstrated 1) segmental flow acceleration with peak systolic frequency of
more than 3 KHz with or without high energy low frequency direct or reverse
components; or 2) segmental increase in systolic peak frequency of more
than 20%. Using these criteria, we confirmed through TCD the presence of
MCA stenosis in nine out of 12 cases with diameter reduction of at least
50%, and one among four cases with less than 50% diameter reduction.
Although our results are consistent with Aaslid and von Reutern's figures,
methodological problems and diagnostic criteria have to be improved.
Nevertheless, TCD seems to be a useful tool for the detection of stenosis
with at least 50% diameter reduction, where it proved to offer a 75%
sensitivity. Further studies are necessary to improve sensitivity and
specificity.
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