경두개 초음파를 이용한 만성 중대뇌동맥 폐색의 진단

Abstract

Background and Objectives : Transcranial Doppler (TCD) findings in chronic middle cerebral artery (MCA) occlusion are diverse due to collateral circulation. However, the studies focused on this issue are scarce. This study aimed to determine TCD patterns in chronic MCA occlusion and to estimate the accuracy of TCD in the evaluation of collateral circulation. Methods : We reviewed 13 patients (12 men, 1 women, age = 56.1 ¡¾11.8 years with chronic MCA occlusion confirmed by transfemoral cerebral angiogram (TFCA) and magnetic resonance angiogram (MRA) during the past 2.5 years in Seoul National University Hospital. The patients with cardiac embolic MCA occlusion, moyamoya disease, vasculitis or ipsilateral internal carotid artery stenosis more than 50% were excluded, Flow velocities (FV) of anterior, middle, posterior cerebral arteries (ACA, MCA, PCA) on TCD were analysed. Basal and leptomeningeal collateral circulation through ACA or PCA were evaluated with TFCA. We correlated TCD findings with TFCA results. Results : MRA showed occlusion in MCA in all cases. Basal collaterals were found in all patients, increased ACA collateral flow in 12, and increased PCA collateral flow in seven patients on TFCA. We found three TCD patterns: 1) normal MCA FV with increased ipsilateral ACA or PCA FV (n=4); 2) normal M1 FV with loss of M2 signal and increased ipsilateral ACA or PCA FV (n=4); and 3) increased M1 FV with distal dampening and increased ipsilateral ACA or PCA FV (n=5). The sensitivity and specificity of TCD were 83.3% and 100% to detect increased ACA collateral flow and 57.1% and 83.3% to detect increased PCA collateral flow. Conclusions : Basal collateral network may be mistaken for the MCA Doppler signal. TCD may be very useful in the evaluation of leptomeningeal collaterals in chronic MCA occlusion. Korean Journal of Stroke 2001;3(1): 71~75