Diagnostic Value Of Transcranial Doppler Ultrasound In Diagnosis Of Vetrebral Basilar Artery Stenosis Or Occlusion

Objective: To explore the application value of Transcranial DopplerUltrasound（TCD） in clinical diagnosis of vertebral basilar artery stenosisor occlusion, using magnetic resonance angiography (MRA) as thereference standard.Methods:221ischemic cerebral vascular disease patients by TCDshowed vertebral-basilar artery stenosis or occlusion were included in thisstudy. Patients must undergo MRI within1week. According to the resultsof the MRA patients were divided into the normal group and the stenosisgroup. The peak systolic velocity (PSV), end-diastolic velocity (EDV),mean flow velaocity (MFV), pulsation index (PI) and the TCD spectrum ofeach VBA were recorded and the results of two groups of detection werecompared and analyzed. The coincidence rate of VBA stenosis or occlusiondiagnosis by TCD and MRA was calculated with Kappa number.Results:221patients (84.62%males and15.38%females; mean age:60.02±10.98yrs) in the hospital from July2013to October2014wereincluded in this study. A total of655arteries, including218left vertebralarteries (33.28%),216right vertebral arteries (32.98%),434vertebralarteries (66.26%),221basilar arteries (33.74%),8cases of unilateralvertebral artery were detected. TCD showed350(53.44%) normal vessels,305(46.56%) stenotic vessels. MRA showed324(49.47%) normalvessels,including118basilar arteries,108left vertebral arteries,98rightvertebral arteries;331(50.53%) stenotic vessels, including103basilar arteries,110left vertebral arteries,118right vertebral arteries. Thesensitivity, specificity, false positive rate and false negative rate of TCDdiagnosed vertebral artery stenosis or occlusion were78.95%,83.98%,16.02%,21.05%, the coincidence rate was81.34%, Kappa value0.6226.The sensitivity, specificity, false positive rate, false negative rate of TCDdiagnosed basilar artery stenosis or occlusion were79.61%,91.53%,8.47%,20.39%, the coincidence rate was85.97%, Kappa value of0.7162(95%confidence limit of0.6241,95%confidence limit of0.8083). The overallsensitivity, specificity, false positive rate, false negative rate of TCDdiagnosed vertebral basilar artery stenosis or occlusion were79.15%,86.73%,13.27%,20.85%, the coincidence rate was82.90%, Kappa valueof0.6583(95%confidence limit of0.6008,95%confidence limit of0.7157).Conclusions: TCD has high specificity and sensitivity in diagnosingvertebral-basilar artery stenosis or occlusion, the specificity is higher thanthe sensitivity. TCD can distinguish normal and stenotic VBA. TCD can beused as a preliminary screening method of vertebral basilar artery stenosisor occlusion in patients with cerebral infarction.