Transcranial duplex sonography of middle cerebral artery stenosis: a comparison of colour-coding techniques--frequency- or power-based Doppler and contrast enhancement

The main limitation of transcranial colour-coded duplex sonography (TCCD) is the inadequate acoustic window, which prevents transtemporal identification of the basal cerebral arteries in up to 30% of cases, especially in the elderly. TCCD with different colour-coding techniques, including frequency-based colour-flow (CFD) or power (PD) Doppler sonography, used alone or in combination with contrast media, were used in 23 patients with middle cerebral artery (MCA) stenosis. In 10 patients a contrast medium (400 mg/ml SHU 508 A) was administered because of inadequate colour-coded visualisation with TCCD. The data were compared with angiographic methods. Digital subtraction angiography (DSA) revealed 2 low-grade, 11 middle-grade and 10 high-grade stenoses in the M1 segment. With TCCD, we found a 7.7% higher blood flow velocity (systolic peak velocity) than with transcranial duplex sonography without colour-coding because of visual angle correction and a 20% higher systolic peak velocity using contrast enhancement. CFD did not differ from PD in identification of low- and middle-grade MCA stenoses, but PD alone revealed two more cases of high-grade stenosis than CFD. The contrast medium increased diagnostic confidence in 8 of 10 cases. Only 2 of 23 MCA stenoses (9%) could not be shown using TCCD.