Significance And Value Of Transcranial Doppler Ultrasound In The Diagnosis Of Intracranial Artery Stenosis In Acute Cerebral Infarction

Background and Objective: Intracranial artery stenos(ICAC)is one of the most common causes of acute cerebral infarction(ACI).Multiple tests such as MRA,CTA,and especially DSA can confirm the diagnosis.Transcranial Doppler(TCD)is a convenient and practical screening tool that can also be found in ICAS.The purpose of this study was to evaluate the clinical significance and value of transcranial Doppler ultrasound(TCD)in the diagnosis of intracranial stenosis in patients with acute cerebral infarction.Methods: Prospectively included ACI patients with a clear diagnosis within 6 hours of onset,TCD examination,intracranial vascular velocity,vascular murmur and spectrum,analysis of vascular stenosis and stenosis,and comparative analysis with MRA.The Kappa test was used to calculate the agreement between MRA and TCD results,and the sensitivity,specificity,and positive and negative predictive values of TCD for the diagnosis of ICAS were calculated.Results: A total of 150 ACI patients were included in the study.During the TCD examination,18 patients were excluded due to the acoustic effects of the bone window;6 patients had MR contraindications(metal implants,pacemakers),9 patients had cerebral hemorrhage after intravenous thrombolysis,and 2 A patient with a brain tumor was removed.The remaining 115 patients were diagnosed as acute cerebral infarction by MRI,including 77 males(66.95%)and 38 females(33.04%).The patient's age was 68.32 ± 10.66 years(range 29 to 80).The National Institutes of Health Stroke Scale(NIHSS)average score = 4(range 2-24 points).Of the 115 patients enrolled,48(41.7%)had large atherosclerotic cerebral infarction,44(38.2%)had small arteriolar occlusion,and 5(4.3%)had cardiogenic stroke.The ischemic brain of unknown origin Of the 11 patients(9.5%)with Undetermined etiology(UDE)and 7 patients(6.0%)with other defined causes of ischemic cerebral infarction(ODE).The calculated Kappa coefficient values were used to determine that the consistency of the anterior circulation artery between TCD and MRA was 0.56(moderate agreement)and the posterior circulation artery was 0.40(Fair agreement).TCD was normal in 32(27.82%)patients,and 17(14.78%)patients had normal MRA scans.TCD revealed stenosis in anterior circulation in 57(49.56%)cases and in posterior circulation in 26(22.60%)cases.MRA finding were positive for the anterior circulation in 64(55.65%)cases and in posterior circulation in 34(29.56%)cases.For the anterior circulation,compared with angiography TCD showed 54 true-positive,10 false-negative,3 false positive,and48 true-negative.For the posterior circulation,result were 12 true-positive,22 false-negative,14 false-positive,and 67 true-negative.The sensitivity,specificity,positive predictive value,and negative predictive value of ICAS were 84.4%,95.5%,94.7%,and 82.8% of the anterior circulation,and 64.7%,82.7%,46.2%,and 75.3.% of the posterior circulation,respectively.TCD is compared to MRA.Conclusions: Moderate agreement of anterior circulation stenosis and Fair agreement for posterior circulation stenosis was found between TCD and MRA in the evaluation of ICAS.In anterior circulation,the diagnostic accuracy of TCD is higher compared to the posterior circulation.