Transcranial colour-coded duplex sonography of cerebral arteriovenous malformations

A transcranial colour-coded duplex sonography (TCCD) study was performed to evaluate the sensitivity of detection and the feasibility of visualising details of cerebral arteriovenous malformations (AVMs). We prospectively examined 15 patients with 2 large (> 4 cm), 7 medium-size (2-4 cm) and 6 small (< 2 cm) radiologically proven supratentorial AVMs of the brain using TCCD. A feeding vessel was diagnosed if the velocities and/or the relative interhemisphere velocity difference between feeding and non-feeding anterior, middle and posterior cerebral arteries were more than two standard deviations above the means of 136 age- and sex-matched normals. The sonographer was blinded to the results of cerebral angiography. Using TCCD it was possible to detect all large and medium-size lesions, and 4 of 6 small ones, because 23 of 29 (79%) feeding arteries showed abnormal haemodynamics. In addition, 8 of 46 (17%) feeding branches of cerebral arteries were shown. However, all but 2 large draining veins and sinus were not detected. In view of the availability of MRI, MRA and angiography, TCCD is not the method of choice in screening for cerebral AVMs. However, careful assessment of the velocities in the intracranial arteries permits incidental detection of cerebral AVMs and characterisation of the haemodynamics in the feeding arteries.