title: Transcranial color-coded real-time sonographic criteria for occlusion of the middle cerebral artery in acute ischemic stroke.
abstract: OBJECTIVE
  Transcranial color-coded real-time sonography (TCCS) is a useful tool to evaluate disease of the middle cerebral artery (MCA). This study was undertaken to identify TCCS criteria for the diagnosis of MCA stem and MCA branch occlusions.
  
  
  METHODS
  TCCS and digital subtraction angiography were performed in 55 consecutive patients with acute stroke: 10 with MCA stem occlusion, the MO group; eight with MCA branch occlusion, the MB group; and 37 with nonocclusive lesions, the control group. We measured the end-diastolic velocity (EDV) of the bilateral MCA stems and calculated the end-diastolic ratio by dividing the EDV of the unaffected side by that of the affected side.
  
  
  RESULTS
  EDV was highest in the control group, and end-diastolic ratio was highest in the MO group. An EDV of >25 cm/s indicated a nonocclusive lesion in the MCA, with a positive predictive value of 98.4%, a negative predictive value of 81.0%, and an accuracy of 93.9%. An EDV of <or=25 cm/s with an end-diastolic ratio of <2.7 indicated an MCA branch occlusion with a positive predictive value of 85.7%, a negative predictive value of 97.2%, and an accuracy of 95.3%. An EDV of <or=25 cm/s with an end-diastolic ratio of >or=2.7 indicated MCA stem occlusion with a positive predictive value of 100%, a negative predictive value of 100%, and an accuracy of 100%.
  
  
  CONCLUSIONS
  We developed TCCS criteria for the diagnosis of MCA diseases. MCA flow velocity detected by means of TCCS can help identify MCA stem occlusion as well as MCA branch occlusion.
authors.affiliation: Department of Medicine, Cerebrovascular Division, National Cardiovascular Center, Osaka, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ogata
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakajima
authors.forename: Kouichi
authors.initials: K
authors.lastname: Ikeno
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Naritomi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D002545:Brain Ischemia / Q000150:complications*; D016022:Case-Control Studies; D002533:Cerebral Angiography; D003199:Computer Systems; D003971:Diastole; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology*; D014463:Ultrasonography