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Three-dimensional transcranial Doppler blood flow mapping in patients with cerebrovascular disorders
K Niederkorn1, L G Myers, C L Nunn
1Department of Neurology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.
Insights
Three-dimensional transcranial Doppler (3D TCD) blood flow mapping accurately identifies cerebrovascular disorders. This non-invasive technique aids in diagnosing intracranial stenosis and evaluating collateral flow mechanisms.
Area of Science:
- Neuroscience
- Medical Imaging
- Vascular Biology
Background:
- Cerebrovascular disorders pose significant health challenges.
- Accurate assessment of cerebral blood flow is crucial for diagnosis and management.
- Traditional methods may have limitations in visualizing complex vascular anatomy.
Purpose of the Study:
- To evaluate the efficacy of three-dimensional transcranial Doppler (3D TCD) blood flow mapping.
- To assess its ability to identify and characterize cerebrovascular abnormalities.
- To compare 3D TCD findings with conventional angiography.
Main Methods:
- Sixty patients with cerebrovascular disorders were studied.
- A computer-assisted 3D TCD system was used for blood flow mapping.
- Vessel identification, blood flow velocity, and direction were documented in basal cerebral arteries.
Main Results:
- The basilar artery was visualized in all patients, with high detection rates for middle cerebral, internal carotid, anterior cerebral, and posterior cerebral arteries.
- Abnormal results were observed in 38% of patients.
- Significant intracranial stenosis or occlusion was found in 32% of patients with ischemic events.
- Collateral flow mechanisms were demonstrated in cases of extracranial carotid occlusion.
Conclusions:
- 3D TCD blood flow mapping is a reliable method for diagnosing cerebrovascular disorders.
- It accurately identifies intracranial stenosis and assesses collateral circulation.
- Diagnostic accuracy was confirmed by intra-arterial cerebral angiography in 90.5% of cases.
Abstract:
We investigated 60 patients with cerebrovascular disorders using a three-dimensional transcranial Doppler blood flow mapping system. A composite display of the circle of Willis is created with computer assistance, allowing accurate vessel identification and optimal data documentation of blood flow velocity and direction in the basal cerebral arteries. The basilar artery was insonated in every patient; the middle cerebral artery and the most distal internal carotid artery were found in 95% of the patients, the anterior cerebral artery in 85%, and the posterior cerebral artery in 84%. Insonation problems occurred predominantly in elderly women. Transcranial Doppler blood flow mapping showed an abnormal result in 23 of 60 patients (38%). An intracranial stenosis with greater than 50% diameter reduction or occlusion was found in 10 of 31 patients (32%) with completed stroke, reversible ischemic neurologic deficit, or transient ischemic attack. Collateral blood flow mechanisms could be demonstrated in patients with extracranial carotid artery occlusions. Intra-arterial cerebral angiography performed in 21 patients confirmed the transcranial Doppler blood flow mapping diagnosis in 19 (90.5%). In one patient an arteriovenous malformation diagnosed by transcranial Doppler blood flow mapping was confirmed by magnetic resonance imaging.