Diagnosis of middle cerebral artery stenosis by transcranial color-coded real-time sonography.
OBJECTIVE
This study was performed to determine the usefulness of transcranial color-coded real-time sonography (TCCS) in detecting stenosis in the horizontal portion of the middle cerebral artery (MCA).


METHODS
Using TCCS and the incident angle correction technique, we measured the peak-systolic flow velocity in bilateral MCAs in 45 consecutive patients in whom cerebral angiography was carried out within 1 week before or after TCCS. Three patients had a stenosis of 75% or greater and four had a unilateral occlusion of the extracranial internal carotid artery (ICA) (the ICS and ICO groups, respectively). Eight patients had a stenosis of 50% or greater (one bilateral and seven unilateral) (the M1S group). Four patients had unilateral distal occlusion of the horizontal portion of the MCA (the M1O group). Twenty-six patients had no significant extra- or intracranial stenosis on the ipsilateral or contralateral side (the control group).


RESULTS
Mean peak-systolic flow velocity on the affected side was 83.0 +/- 20.8 cm/s in the ICS group, 59.8 +/- 23.2 cm/s in the ICO group, and 62.3 +/- 33.7 cm/s in the M1O group. In the control group, the mean peak-systolic flow velocity was 116.0 +/- 31.5 cm/s. In the M1S group, however, the mean peak-systolic flow velocity (334.2 +/- 35.7 cm/s) on the affected side always exceeded 180 cm/s (mean value +/- 2 SD in the control group), and was significantly higher than that in the other groups. The mean peak-systolic flow velocity in the M1S group increased with the grade of stenosis.


CONCLUSIONS
The M1S group members could easily be distinguished from the other group members by their peak-systolic flow velocity in excess of 180 cm/s. Measurement of the peak-systolic flow velocity of the MCA by TCCS may help to identify a significant stenosis in the horizontal portion of the MCA.
Kimura
K
K
Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Yasaka
M
M
Wada
K
K
Minematsu
K
K
Yamaguchi
T
T
Otsubo
R
R
D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial