Noninvasive detection of diffuse intracranial disease

Area of Science:

• Neuroscience
• Vascular Neurology
• Medical Imaging

Background:

• Intracranial arterial stenosis is a significant risk factor for stroke.
• Traditional hemodynamic assessments may not fully capture the complexity of diffuse stenoses.
• Novel diagnostic criteria are needed to accurately assess widespread intracranial arterial narrowing.

Purpose of the Study:

• To evaluate the frequency and diagnostic accuracy of focal and diffuse intracranial stenoses.
• To utilize novel criteria accounting for increased flow resistance in widespread lesions.
• To assess the utility of transcranial Doppler (TCD) in detecting intracranial stenosis.

Main Methods:

• Patients with cerebral ischemia symptoms underwent neurovascular ultrasound.
• Transcranial Doppler mean flow velocities and pulsatility index were analyzed.
• Contrast angiography (CT angiography or digital subtraction angiography) served as the gold standard for diagnosis.

Main Results:

• The study included 153 patients with a history of stroke or transient ischemic attack.
• Transcranial Doppler demonstrated high sensitivity (79.4%) and specificity (92.4%) for detecting intracranial disease.
• Low mean flow velocities and high pulsatility index on TCD were independently associated with diffuse intracranial disease.

Conclusions:

• Diffuse intracranial disease is more frequent than expected in certain stroke populations.
• Noninvasive screening using transcranial Doppler can effectively detect diffuse intracranial stenosis.
• These findings support the use of TCD for identifying widespread cerebral artery narrowing.