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 less than or equal to 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 less than or equal to 25 cm/s with an end-diastolic ratio of greater than or equal to 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 now velocity detected by means of TCCS can help identify MCA stem occlusion as well as MCA branch occlusion.