Comparison of transcranial color-coded sonography and magnetic resonance angiography in acute stroke

Background and Purpose We sought to compare the ability of transcranial color-coded Doppler sonography (TCCS) and magnetic resonance angiography (MRA) to identify circulatory changes that occur after acute stroke. Methods Forty-four patients with a clinical diagnosis of acute stroke were studied with both TCCS and MRA within 24 hours of stroke onset. The appearances of all vessels identified on MRA were divided into three categories: normal, attenuated, and absent vessels. The basal cerebral arteries were identified with the use of TCCS, and their velocities were measured with pulsed-wave Doppler. The side-to-side asymmetry was calculated and expressed as an asymmetry index. Results Five patients could not be studied with TCCS because of lack of a suitable acoustic window. An additional 4 patients were too restless to tolerate MRA scanning. Three patients had intracerebral hemorrhages, 2 patients had intracerebral gliomas, and the remaining 30 patients had cerebral infarctions. In the group of patients with acute cerebral infarction, TCCS identified 10 patients with normal asymmetry indices, 1 patient with an increased asymmetry index, 9 patients with decreased asymmetry indices, and 10 patients with occlusion of the symptomatic middle cerebral artery (MCA). MRA identified 8 normal angiograms, 6 patients had attenuated MCA branch vessels, 4 patients had MCA branch occlusions, 2 angiograms demonstrated MCA main stem attenuation, and 10 angiograms showed MCA occlusion. Conclusions TCCS and MRA are both noninvasive techniques that can be used to study the acute stroke patient. They both yield information regarding the pathophysiology of acute stroke and may be useful techniques in deciding on therapeutic interventions. The findings agree closely with each other, and these techniques may be useful in the long-term follow-up of stroke patients.