Correlation of magnetic resonance angiography and transcranial doppler ultrasound in acute stroke patients
1 Department of Radio-diagnosis, Shridevi Institute of Medical Sciences & Research Hospital, Tumkur – 572106, Karnataka, India.
2 Consultation Radiologist, Director, Sridevi Diagnostics, Pune, Maharashtra, India.
Research Article
International Journal of Frontiers in Medicine and Surgery Research, 2023, 03(01), 028–037.
Article DOI: 10.53294/ijfmsr.2023.3.1.0062
Publication history:
Received on 20 April 2023; revised on 28 May 2023; accepted on 30 May 2023
Abstract:
The incidence of cerebrovascular diseases increases with age, and the number of strokes is projected to increase as the elderly population grows. Most cerebrovascular diseases are manifest by the abrupt onset of a focal neurologic deficit. Computed Tomography images identify or exclude hemorrhage as the cause of stroke, and they identify extra-parenchymal hemorrhages, neoplasms, abscesses, and other conditions masquerading as stroke. Non-contrast CT brain is the 1st imaging investigation usually performed in acute stroke patients.
Magnetic Resonance Imaging (MRI) reliably documents the extent and location of infarction in all areas of the brain, including the posterior fossa and cortical surface. It also identifies intracranial hemorrhage and other abnormalities but is less sensitive than CT for detecting acute blood. Diffusion-weighted imaging is more sensitive for early brain infarction than standard MR sequences or CT, as is fluid-attenuated inversion recovery (FLAIR) imaging. Using IV administration of gadolinium contrast, MR perfusion studies can be performed. Thus it is evident that both TCD and MRA are promising modalities in the evaluation of acute stroke. This dissertation aims to compare and correlate the findings of MRA and TCD and their advantages and disadvantages in the practical hospital set-up.
Total 50 patients – 30 Male and 20 Females – with a clinical diagnosis of stroke (Acute or Chronic) were evaluated with MRI and MR Angiography and Transcranial Doppler(TCD) with TCD being performed prior to MRI/MRA in all patients. Time interval between these two examinations was 2 to 8 hours.
Out of 50 patients studied, 10 patients were excluded due to inadequate insonation windows. Of the 40 patients, 24 patients showed abnormality on MRA. Of the MRA abnormal 24 patients, 20 were abnormal on TCD (True positive on TCD), while 4 were normal on TCD (False negative on TCD). Also of the 16 MRA normal patients, 9 were normal on TCD (True negative) while 7 were abnormal on TCD (False positive). Analysis of above findings revealed, Sensitivity 83.33 %, Specificity 56.25%, Positive predictive value 74.07 %, Negative predictive value 69.23 % for TCD compared to MRA in Assessment of the Anterior circulation.
Keywords:
Transcranial Doppler; Stroke; Cerebrovascular Accident; Magnetic Resonance Imaging
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