Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients.

Shengqi Fu,Shuling Zhang,Hongtao Zhang,Jiewen Zhang

doi:10.1590/0004-282x20190050

Abstract

To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.

Highlights

The results showed that only age and middle cerebral artery (MCA) pulsatility index were significantly correlated with severe white matter lesions (WMLs)
Results of analysis on transcranial Doppler (TCD) ultrasound parameters Analysis of the TCD ultrasound parameters showed that when the cut-off of the mean MCA pulsatility index was 1.04 cm/s, this could identify whether the patients had severe WMLs or not
The TCD ultrasound is a reliable method for early diagnosis of intracranial arterial ischemic lesions, and can provide an objective hemodynamic basis for the selection of treatment methods for intracranial atherosclerotic lesions[21]

Summary

Introduction

Cerebral white matter lesions (WMLs), lacunar infarction and microhemorrhage are the main MRI indications of cerebral small vessel disease[9,10,11]. The pulsatility index, a parameter of TCD ultrasound, has been used for many years to reflect the resistance of small vessels[15,16,17]. This study aimed to investigate the relationship between the pulsatility index in TCD ultrasound and cerebral small vessel disease in elderly patients.

Results

Conclusion