Vertebral and Basilar Arteries: Transcranial Color-Coded Duplex Ultrasonography versus Conventional TCD in Detection of Narrowings

Abstract

We prospectively compared the accuracies of conventional transcranial Doppler ultrasound (TCD) and transcranial color-coded duplex sonography (TCCS) in the diagnosis of narrowing of the basilar (BA) and vertebral arteries (VA). Fifty-six consecutive patients (mean age 55.8 years; 34 women) after subarachnoid hemorrhage (n=46), stroke or transient ischemic attack (n=5), and for other reasons (n=5) underwent on the same day TCD, TCCS and the intra-arterial digital subtraction angiography (DSA) – the reference standard. The accuracy of peak-systolic (V_PS), mean (V_M), and end-diastolic velocities (V_ED) in detection of any arterial narrowing was estimated using the receiver operator characteristic (ROC) curve methodology and the total area (A_z) under the curve. Accuracy of TCCS in detection of VA narrowing based on V_PS and V_M measurements was significantly higher than accuracy of TCD (A_z =0.65 for V_PS and A_z =0.62 for V_M versus A_z =0.51 and A_z =0.50, respectively, p<0.05 for both). Accuracy of TCCS in detection of BA narrowing was also higher than accuracy of TCD based on V_PS measurements (A_z =0.69 versus A_z =0.50, respectively), with a trend toward significant difference, p=0.085. The accuracy of TCCS is superior to accuracy of TCD in detection of narrowings of vertebral and basilar arteries, thus TCCS should be preferred in routine clinical practice.