Evaluation of flow velocity in unilateral middle cerebral artery stenosis by Transcranial Doppler

To determine the optimal velocity values in diagnosing unilateral middle cerebral artery (MCA) stenosis by Transcranial Doppler (TCD), and improve the diagnostic accuracy using magnetic resonance angiography (MRA), a total of 302 unilateral MCA stenosis patients undergoing TCD also consented to a MRA of the intracranial arteries. The peak systolic velocity (PSV) and each MCA spectrum for each patient were recorded. Using the MRA to confirm, the degree of middle cerebral artery stenosis was categorized into four groups: normal (normal caliber and signal), mild (<50 %), moderate (50-69 %), severe (70-99 %, or no flow detected). The velocity difference among these four groups was significant (P < 0.001). The optimal PSV values for normal and stenosis were 160 cm/s. For mild and moderate were 200 cm/s, for moderate and severe were 280 cm/s. Using PSV as the diagnostic criteria, the Kappa number was >0.668. The optimal PSV differential value for mild and moderate was 70 cm/s, for moderate and severe at 120 cm/s. Optimal combined criteria for moderate stenosis were PSV >200 cm/s and PSV differential value >70 cm/s (specificity 87.2 %), for severe stenosis were PSV >280 cm/s and PSV differential value >120 cm/s (sensibility 81.6 %). Transcranial Doppler distinguishes normal and MCA stenosis with a reduced lumen diameter of less than 50 %. Using the PSV criteria, TCD has a high coincidence rate with MRA in the diagnosis of MCA stenosis. Combined PSV differential value and the abnormal spectrum may improve the accuracy of TCD in diagnosing moderate or severe stenosis.