Abstract:

Objective To explore the clinical value of multimodal ultrasound involving both carotid ultrasound and Transcranial color-coded duplex sonography (TCCD) in screening middle cerebral artery stenosis in hypertensive patients. Methods Sixty hypertensive patients admitted to our hospital who underwent carotid ultrasound, TCCD, and digital subtraction angiography (DSA) were selected as the study subjects. According to the presence of the middle cerebral artery stenosis detected by DSA or not, patients were divided into experimental group (middle cerebral artery stenosis, n=30) and control group (non-stenosis, n=30). The morphological and hemodynamic changes of carotid ultrasound were compared between groups. The consistency of the middle cerebral artery stenosis diagnosed by TCCD with that by DSA was analyzed. Results There were no significant differences in thickness of the carotid artery intima media and the incidence of plaques between experimental group and control group (P>0.05). The number of involved plaques, and the incidence of stenosis in the common carotid artery and internal carotid artery were significantly higher in the experimental group than those in the control group (P<0.05). There was no significant difference in the peak systolic flow velocity of the affected internal carotid artery between the two groups (P>0.05). The end diastolic flow velocity of the internal carotid artery in the experimental group was significantly lower than that in the control group, while the resistance index was significantly higher (P<0.05). Pearson correlation analysis showed that the end diastolic flow velocity of the affected internal carotid artery was negatively correlated with the middle cerebral artery stenosis (r=-0.39), and the resistance index was positively correlated with middle cerebral artery stenosis (r=0.28). The Kappa value of TCCD and DSA in diagnosing the middle cerebral artery stenosis was 0.895 (95%CI: 0.756-1.034), with a diagnostic accuracy of 93.3%. Conclusion There is a certain correlation of the morphology and hemodynamics of carotid ultrasound structure with the middle cerebral artery stenosis, which has a certain warning value. The combination of carotid ultrasound with TCCD is able to identify the degree of disease, showing a consistency with that diagnosed by DSA. It is preferred to the screening of the middle cerebral artery stenosis in hypertensive patients.

Key words: carotid ultrasound, transcranial color duplex sonography, multimodal ultrasound, middle cerebral artery stenosis, hypertension