Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Cerebrovascular Diseases (Impact Factor: 3.75). 01/2012; 33(3):272-9. DOI: 10.1159/000333449
Source: PubMed


Failure to detect the sphenoidal segment of the middle cerebral artery (M1) on transcranial color-coded sonography (TCCS) results from either M1 occlusion or an insufficient temporal bone window (TBW). We sought to identify a simple indicator on B mode images for M1 evaluation.
Consecutive acute ischemic stroke patients with an intact M1 segment underwent prospective TCCS evaluation. Visibilities of the contralateral temporal bone (CTB), midbrain (MB) and lesser sphenoid wing (LSW) on B mode images were defined as follows: 'invisible', 'poor' if the contour was less than 50% visible, 'fair' if more than 50% visible and 'good' if totally visible. M1 detectability on color Doppler images was defined as follows: 'INVISIBLE', 'POOR' if the M1 was detected as color dots, 'FAIR' if linearly but discontinuously detectable, and 'GOOD' if linearly and continuously detectable. The relationship between each structure's visibility and M1 detectability was assessed.
Seventy-six patients with 152 TBWs were evaluated. The CTB was 'invisible' in 2%, 'poor' in 22%, 'fair' in 36% and 'good' in 40%. Visibility of the MB was 36, 24, 26 and 14%, respectively. Visibility of the LSW was 16, 22, 29 and 32%, respectively. The M1 was 'INVISIBLE' in 51%, 'POOR' in 7%, 'FAIR' in 7% and 'GOOD' in 35%. Spearman's rank correlation coefficient between each structure's visibility and M1 detectability was 0.68 for the CTB, 0.66 for the MB and 0.80 for the LSW, respectively (p < 0.001 for all).
Visibility of the LSW on B mode appears to be a better indicator than other structures for M1 evaluation.

8 Reads
  • Source
    • "Detectability of A2 segment of the ACA and V3 segment of the VA is an advantage. Furthermore, unavailability of sufficient bone window can also be detected promptly by the sonic appearance of the contralateral skull band and ipsilateral planum temporale on B-mode imaging (Suzuki et al. 2012). TCDI, albeit not considered as the firstline imaging modality, can be used to diagnose and determine of size of intracerebral space occupying lesions including intracerebral hemorrhages and monitor of the midline shift caused by these lesions (Becker et al. 1993; Gerriets et al. 1999). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Albeit no direct anatomical information can be obtained, neurosonological methods provide real-time determination of velocity, and spectral waveform of blood flow in basal intracranial arteries adds significant benefit to the care of the patients with neurovascular diseases. Several features, such as relative simplicity in terms of interpretation and performance, significantly low cost, totally non-invasiveness, portability, and excellent temporal resolution, make neurosonology increasingly popular tool for evaluation, planning, and monitoring of treatment, and for determining prognosis in various neurovascular diseases. Usefulness of transcranial Doppler in diagnosing/monitoring subarachnoid hemorrhage related vasospasm and sickle cell vasculopathy is already well known. Utility in diagnosis of intracranial arterial stenosis, acute occlusion and recanalization, intracranial hemodynamic effect of the cervical arterial pathologies, intracranial pressure increase, and cerebral circulatory arrest are also well established. Neurosonological determination of vasomotor reactivity, cerebral autoregulation, neurovascular coupling, and micro-embolic signals detection are useful in the assessment of stroke risk, diagnosis of right-to-left shunting, and monitoring during surgery and interventional procedures. Transcranial Doppler is also an evolving ultrasound method with a therapeutic potential such as augmentation of clot lysis and cerebral delivery of thrombolytic or neuroprotective agent loaded nanobubbles in neurovascular diseases. The aim of this study is to give an overview of current usage of the different ultrasound modalities in different neurovascular diseases.
    Preview · Article · Nov 2012 · Journal of Neurochemistry
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to sonographically assess the cerebral hemodynamic differences and changes after oxygen therapy in healthy youths of different ethnicities in Tibet. Sixty-six healthy young Han visitors and 29 healthy young Tibetan residents were divided into 4 groups. Basic information was collected. Pulsed Doppler sonography was used to record the cerebral hemodynamic parameters for the internal carotid, vertebral, and middle cerebral arteries. The participants were then instructed to inhale oxygen, and basic information and cerebral hemodynamic parameters were recorded at 1, 2, 4, and 8 minutes, respectively. Differences in these parameters between groups were analyzed. In comparisons of the flow parameters between sex-matched groups, the mean resistive index values for the internal carotid, vertebral, and middle cerebral arteries in the Han groups were significantly lower than those in the Tibetan groups (P <. 05). The mean peak systolic velocity, end-diastolic velocity, and mean velocity values for the middle cerebral artery in the Han groups were significantly higher than those in the Tibetan groups (P < .05). After oxygen uptake, there were no significant differences in the mean arterial oxygen saturation, heart rate, mean velocity, and resistive index values between the male groups, and similar changes were found for the arterial oxygen saturation and peak systolic velocity values between female groups after 8 minutes of oxygen uptake (P > .05). Sonography is a useful modality for noninvasive and real-time detection of changes in cerebral hemodynamics and can provide reference values for the prevention and treatment of cerebrovascular diseases. © 2015 by the American Institute of Ultrasound in Medicine.
    No preview · Article · Jun 2015 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine