Diagnosis of middle cerebral artery occlusion with transcranial color-coded real-time sonography.
OBJECTIVE
To determine the usefulness of transcranial color-coded real-time sonography in detecting occlusion of the horizontal portion of the middle cerebral artery.


METHODS
Using transcranial color-coded real-time sonography, we measured the end-diastolic flow velocity with incident angle correction and the side-to-side ratio of the end-diastolic flow velocity (the end-diastolic ratio) in both middle cerebral arteries in 44 patients with or without occlusive disease. Cerebral angiography was carried out in all patients before or within 1 week after sonography. The subjects included 4 patients with unilateral stenosis of the extracranial internal carotid artery > or = 75%; ICS group), 6 with unilateral occlusion of the extracranial internal carotid (ICO group), 6 with occlusion of the horizontal portion of the middle cerebral artery (M1 group), and 28 without stenotic (< 75%) lesions in the internal carotid artery (control group).


RESULTS
In the control group, the end-diastolic flow velocity was 40.4 +/- 16.8 cm/s (mean +/- SD) and the end-diastolic ratio was 1.28 +/- 0.27. In the ICS and ICO groups, the end-diastolic flow velocities on the affected side and the end-diastolic ratios were 33.4 +/- 9.0 cm/s and 1.35 +/- 0.24, and 29.6 +/- 10.2 cm/s and 1.67 +/- 0.58, respectively. In the M1 group, the end-diastolic flow velocity (16.7 +/- 4.29 cm/s) on the occluded side was significantly lower than that in the other groups. The end-diastolic ratio (3.53 +/- 1.47) in the M1 group was significantly higher than that in the other groups.


CONCLUSIONS
The M1 group could be easily distinguished from the other groups on the basis of the end-diastolic ratio. Measurement of the end-diastolic flow velocity and the end-diastolic ratios in the middle cerebral artery by means of transcranial color-coded real-time sonography may help to identify an occlusion in the horizontal portion of the middle cerebral artery.
Kimura
K
K
Department of Cerebrovascular Disease, Kumamoto City Hospital, Japan.
Hashimoto
Y
Y
Hirano
T
T
Uchino
M
M
Ando
M
M
D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial