Roles Of Color Doppler Ultrasonography And Transcranial Color-coded Sonography In The Evaluation Of Intracranial And Extracranial Arterial Stenosis

Objective: To investigate the clinical value of color Doppler ultrasonography(CDUS)for the evaluation of extracranial arterial stenosis,transcranial color-coded sonography(TCCS)for the evaluation of intracranial arterial stenosis,and a combination of them in the assessment of intracranial and extracranial arterial stenosis,find the crux of problem and improve assessment efficacy.Methods: Data of 46 patients with ischemic stroke admitted to the first affiliated hospital of Hainan medical university between December 2019 and May 2022 were retrospectively analyzed,with focus on the performances and findings of color Doppler ultrasonography(CDUS)for the assessment of extracranial blood vessels and transcranial color-coded sonography(TCCS)for intracranial blood vessels,as well as both of them as a combination.The results obtained by digital subtraction angiography(DSA)were used as the gold standard(Results of computed tomography angiography/magnetic resonance angiography for the blood vessels were applied conjointly in a few challenging cases).Extracranial blood vessels,such as subclavian artery,common carotid artery,internal and external carotid arteries,and vertebral artery outside of the cranial segment were investigated using CDUS.Intracranial blood vessels,such as intracranial vertebral artery(VA4)and basilar artery(BA),middle cerebral artery(MCA),terminal internal carotid artery(TICA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),were investigated using TCCS.All patients received CDUS,TCCS and DSA examinations within one week of admission,and the CDUS and TCCS were performed by the same physician on the same day.The diameters of some target vessels were measured,peak systolic velocity(PSV)and end diastolic velocity(EDV)were determined using pulsed wave Doppler,and resistance index(RI)and pulsatility index(PI)were calculated.The presence or absence of stenosis of the blood vessels were observed or speculated according to the findings by CDUS and TCCS or a combination of the two methods.Kappa test was used to rate the agreements of findings of blood vessels by the CDUS and DSA,and by the TCCS and DSA.The receiver operating characteristic(ROC)curve was drawn,the area under the ROC curve(AUC),sensitivity,specificity,accuracy,odds ratio(OR),positive predictive value and negative predictive value were calculated and studied.Results:1.CDUS evaluated internal carotid artery with high agreement with DSA(Kappa=0.631,P < 0.001).CDUS was not in agreement with DSA in evaluating vertebral artery in origin(Kappa=0.364,P <0.001).2.The evaluation of middle cerebral artery by TCCS was highly agreement with that by DSA(Kappa=0.743,P <0.001).TCCS evaluated intracranial vertebral artery was in good agreement with DSA(Kappa=0.836,P <0.001).TCCS evaluated basilar arteries was in moderate agreement with DSA(Kappa=0.568,P <0.001).3.The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of CDUS for extracranial arterial stenosis were40.00%,58.70%,93.75%,92.31% and 45.45%,respectively.The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of TCCS for intracranial blood vessels were 70.00%,76.09%,87.50%,91.30% and60.87%,respectively.The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of a combination of CDUS and TCCS for the evaluation of for intracranial and extracranial blood vessels were 83.33%,82.61%,81.25%,89.29% and 72.22%,respectively.The OR value increased from1.42 by CDUS to 4.75 by a combination of CDUS and TCCS.The AUC of CDUS for the assessment of extracranial arterial stenosis was 0.669,the AUC of TCCS for the assessment of intracranial arterial stenosis was 0.787,respectively,and there was no statistical difference between them(Z= 1.402 P= 0.161).The AUC of a combination of CDUS and TCCS for the assessment of intracranial and extracranial arterial stenosis was 0.853,which was significantly higher than that of the CDUS and TCCS alone,and the differences were statistically significant(Z=2.838,P < 0.005;Z= 2.346,P =0.019).Conclusions: The sensitivity and accuracy of both CDUS for the assessment of extracranial arterial stenosis and TCCS for the assessment of intracranial arterial stenosis were poor,but the specificity of them was very good;the sensitivity,accuracy,negative predictive value and OR value were significantly improved by the combination of CDUS and TCCS,but the specificity and the positive predictive value were reduced.CDUS has limitations in the evaluation of vessel stenosis of vertebral artery in origin.TCCS has limitations in the evaluation of vessel stenosis of basilar artery.