Transcranial color-coded real-time sonographic criteria for occlusion of the middle cerebral artery in acute ischemic stroke.
BACKGROUND AND PURPOSE
Transcranial color-coded real-time sonography (TCCS) is a useful tool to evaluate disease of the middle cerebral artery (MCA). This study was undertaken to identify TCCS criteria for the diagnosis of MCA stem and MCA branch occlusions.


METHODS
TCCS and digital subtraction angiography were performed in 55 consecutive patients with acute stroke: 10 with MCA stem occlusion, the MO group; eight with MCA branch occlusion, the MB group; and 37 with nonocclusive lesions, the control group. We measured the end-diastolic velocity (EDV) of the bilateral MCA stems and calculated the end-diastolic ratio by dividing the EDV of the unaffected side by that of the affected side.


RESULTS
EDV was highest in the control group, and end-diastolic ratio was highest in the MO group. An EDV of >25 cm/s indicated a nonocclusive lesion in the MCA, with a positive predictive value of 98.4%, a negative predictive value of 81.0%, and an accuracy of 93.9%. An EDV of <or=25 cm/s with an end-diastolic ratio of <2.7 indicated an MCA branch occlusion with a positive predictive value of 85.7%, a negative predictive value of 97.2%, and an accuracy of 95.3%. An EDV of <or=25 cm/s with an end-diastolic ratio of >or=2.7 indicated MCA stem occlusion with a positive predictive value of 100%, a negative predictive value of 100%, and an accuracy of 100%.


CONCLUSION
We developed TCCS criteria for the diagnosis of MCA diseases. MCA flow velocity detected by means of TCCS can help identify MCA stem occlusion as well as MCA branch occlusion.