Transcranial Color Duplex Sonography of Basal Cerebral Arteries: Reference Data of Flow Velocities from Childhood to Adulthood
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Abstract:
A prospective study on transcranial color duplex sonography (TCCD) was performed with 94 healthy children and adolescents between 3 and 18 years of age (age and sex evenly distributed) in order to provide normal data on angle-corrected ("true") flow velocities and wave-form parameters of the main supra- and infratentorial basal cerebral arteries. Using a 2.0 MHz transducer of a computed sonography system, we examined the anterior, middle, and posterior cerebral arteries of either side transcranially, and the vertebrobasilar system suboccipitally. In all arteries, flow velocities decreased continuously from early childhood to adulthood, while wave-form parameters remained constant. There was no difference in flow velocities, and wave-form parameters between girls and boys. On the average, the angle-corrected flow velocities measured by TCCD were about 10%-20% higher than the reference data provided in "blind" transcranial Doppler studies by other groups for the anterior and posterior cerebral arteries as well as the basilar artery, while there were only small differences in the values for the middle cerebral artery. Side-to-side differences in flow velocities were lower in the middle and posterior cerebral arteries than in the anterior cerebral and the vertebral arteries. The reference data presented here provide a basis for the clinical application of the TCCD method in children and adolescents.Keywords:
Posterior cerebral artery
Anterior cerebral artery
Transcranial Doppler
Studies on blood flow velocity in the fetal middle cerebral artery have revealed signs of brain sparing in chronic hypoxia. These signs of brain sparing can disappear in the terminal case, but whether this applies to the whole brain or only parts of it is unknown.Velocity waveforms of the middle cerebral, anterior cerebral and posterior cerebral arteries were recorded in 221 pregnancies complicated by pregnancy-induced hypertension. The presence of brain sparing (pulsatility index < 2 standard deviations) was noted and correlated to outcome of pregnancy, including emergency operative intervention and/or neonatal distress.Signs of brain sparing in the anterior cerebral artery were found in 90 fetuses, and in the middle cerebral and posterior cerebral arteries in 52 and 65, respectively. Signs of brain sparing in the anterior cerebral artery showed the strongest relationship to adverse perinatal outcome. The anterior cerebral artery was the only vessel in which signs of brain sparing were predictive of perinatal mortality.Velocimetry of the anterior cerebral artery appears to be superior to that of the middle cerebral and posterior cerebral arteries as a means to predict adverse perinatal outcome. Anterior cerebral artery brain sparing may therefore be less transitory than sparing in the middle cerebral and posterior cerebral arteries, possibly suggesting that the frontal lobes are spared longer than the lateral and occipital regions of the fetal brain.
Anterior cerebral artery
Posterior cerebral artery
Cerebral hypoxia
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Objective: To observe the courser and morphology of the major cerebral arteries and the inner diameters in their origin, and the display rate of their branches at all levels on multi-slice spiral CT angiographic (MSCTA) imaging in healthy adults. The authors expect to provide useful imaging data for the diagnosis of cerebrovascular diseases. Methods: Forty cases normal series images were selected from the cerebral arterial 64-slice MSCTA images of health volunteer randomly. The inner diameter in their origin, courser and morphology of the main cerebral arteries were observed by an ADW 4.2 workstation. The display rate of their branches at all levels was also calculated. Results: The frequent variability was found in the A1 segment of anterior cerebral artery (ACA), anterior communicating artery (ACoA), posterior communicating artery (PCoA), and P1 segment of posterior cerebral artery (PCA) which constitute a circle of willis, and the noticeable variability was PCoA. The frequency of MSCTA to display the major cerebral arteries including the end segment of ICA, A1 segment of ACA, middle cerebral artery (MCA), PCA, ophthalmic artery (OA), AcoA, PcoA, and anterior choroidal artery (AchA) was 100%, 95%, 100%, 100%, 100%, 92.5%, 58.8% and 72.5% respectively. The inner diameters of the main cerebral arteries were 4.013±0.770 mm, 2.709±0.877 mm, 3.498±0.640 mm, 2.025±0.608 mm, 1.640±0.334 mm, 1.491±0.697 mm and 1.460±0.483 mm respectively for the end segment of ICA, ACA, MCA, PCA, OA, PcoA, and AchA. Conclusion: The cerebral arterial variabilities in healthy adults distributed predominantly in the circle of willis. The diameter of the cerebral arteries is related to their territorial distribution and hemodynamic factors.
Anterior cerebral artery
Posterior cerebral artery
Circle of Willis
Posterior communicating artery
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The performance of transcranial Doppler in the detection of anterior cerebral artery vasospasm and vasospasm in patients after subarachnoid haemorrhage was analysed. Transcranial Doppler and cerebral angiography were performed within the same 24 hours on each of 41 patients with acute subarachnoid haemorrhage. Sensitivity and specificity of transcranial Doppler to classify middle cerebral arteries, anterior cerebral arteries, and patients with angiographic vasospasm were determined at mean velocities of 120 and 140 cm/s. Accuracy of transcranial Doppler was better at 140 than at 120 cm/s. For the middle cerebral artery, sensitivity was 86%, specificity 98%. For the anterior cerebral artery, sensitivity was 13%, specificity 100%. Among all patients, sensitivity was 45%, specificity 96%. Among patients with anterior communicating artery aneurysms, sensitivity was 14%, specificity 90%. Therefore, transcranial Doppler accurately differentiates between middle cerebral arteries with and without vasospasm on angiography, but has a very low sensitivity for detecting anterior cerebral artery vasospasm and vasospasm in patients with anterior communicating artery aneurysms. Since vasospasm may involve anterior cerebral arteries while sparing middle cerebral arteries, especially after rupture of an anterior communicating artery aneurysm, caution should be exercised in using negative transcranial Doppler results to make treatment decisions based on the assumed absence of vasospasm.
Transcranial Doppler
Anterior cerebral artery
Anterior communicating artery
Cerebral Vasospasm
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Posterior cerebral artery
Anterior cerebral artery
Superficial temporal artery
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Objective To investigate the morphology of the cerebral arteries with multi-slice spiral CT angiography(MSCTA) in Chinese adults.Methods MSCTA of 129 Chinese adults were retrospectively analyzed to observe the morphology and patterns of the cerebral arteries.Results On MSCTA,the hypogenesis rate of A1 segment of anterior cerebral artery was 14.73%,and its absence rate 5.43%.The variations of the A1 segment of anterior cerebral artery in males were more than that in females(χ2=5.85,P0.05).The presence rate of anterior communicating artery was 66.67% and 49.61% in posterior communicating artery(in females more than in males(χ2=6.00,P0.05).The presence rate of the fetal type and the transitional configuration posterior cerebral artery was 9.30% and 6.20%,respectively.Conclusion MSCTA is accurate for evaluating the anatomy and variation of cerebral arteries.
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Posterior cerebral artery
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Using a pulsed Doppler velocity meter, the authors assessed by a transcranial approach, in order to obtain an idea on the normal haemodynamics of the basal cerebral arteries, the maximal systolic blood flow (Vmax., m.s-1) in these arteries in a group of 25 healthy young men and in 20 healthy children. In different arteries of the two groups the following mean values of Vmax. were recorded: middle cerebral artery 0.73 +/- 0.11 parallel 0.80 +/- 0.17 m.s-1; anterior cerebral artery 0.55 +/- 0.06 parallel 0.51 +/- 0.09 m.s-1 and posterior cerebral artery 0.44 +/- 0.04 parallel 0.40 +/- 0.02 m.s-1. The assessed values of Vmax. are in agreement with data of other authors. Using the transcranial Doppler method (TD), the authors recorded in 10 children examined in the acute and subsequent stage of cerebrovascular disease recanalization of original occlusions in the anterior, middle and posterior cerebral arteries in the carotid siphon and in the basal artery and improved cerebral haemodynamics in A-V malformation in the basal ganglia. The TD method thus makes it possible to diagnose and follow up the course of these diseases. To illustrate the assessment of the function of the circle of Willis we made in three of our followed up patients with stenosis of extracranial internal carotid arteries static compression tests of both common carotid arteries. The TD method makes it possible to follow up the course of haemodynamic changes in diseases of the cerebral arteries and along with the angiographic examination it extends and supplements the evaluation of the pathological condition of the cerebral arteries and its extent.
Anterior cerebral artery
Circle of Willis
Posterior cerebral artery
Transcranial Doppler
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The purpose of this study was to assess the ability of transcranial Doppler ultrasonography to detect selective circulatory changes during cognitive activity. We measured cerebral artery flow velocity in 21 normal volunteers by transcranial Doppler ultrasonography during rest followed by cerebral activation. Mean and peak systolic flow velocities of the anterior, middle, and posterior cerebral arteries were measured during the performance of a commercial video game. We also measured flow velocity of the anterior cerebral arteries in 18 subjects during a mental arithmetic task. Serial measurements of the right and left sides were made with a headband with two probes. We observed a global increase in the flow velocity above baseline measurements during task performance. During the video game, both middle cerebral arteries (t = 2.6, p = 0.02 for the left; t = 3.3, p = 0.004 for the right) and the left posterior cerebral artery (t = 2.2, p = 0.004) had selective increase in mean flow velocity compared with the ipsilateral anterior cerebral artery. This selective activation was most prominent in the right middle cerebral artery, which had a greater degree of activation than the right posterior cerebral artery (t = 2.8, p = 0.013). We did not observe a statistically significant difference between the right and left middle cerebral arteries, but there was a trend toward a greater activation on the right for both the mean velocity (t = 1.7, p = 0.098) and the peak velocity (t = 1.9, p = 0.079). Our preliminary investigation suggests that this noninvasive technique has the potential to correlate selective cerebral artery flow dynamics with cognitive activity.
Anterior cerebral artery
Transcranial Doppler
Posterior cerebral artery
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PURPOSE To provide transcranial color-coded duplex flow-velocity data for the basal cerebral arteries in patients with unilateral flow-restrictive extracranial carotid artery disease, and to compare these data with the flow velocities obtained in healthy control subjects. METHODS Transcranial color-coded duplex sonography was performed in 78 patients with different patterns of cross flow through the anterior and posterior communicating arteries associated with unilateral obstruction (70% to 100%; 46 stenoses and 32 occlusions) of the internal carotid arteries. Peak systolic, mean, and end diastolic velocities were measured in the anterior, middle, and precommunicating and postcommunicating posterior cerebral arteries. These measurements were compared with the values obtained in 125 age- and sex-matched health control subjects. RESULTS Patients with anterior communicating artery cross flow to the middle cerebral artery (63%) had increased peak velocity in the anterior cerebral artery and decrease peak velocity in the middle cerebral artery on the obstructed (ipsilateral) side, and increased peak velocity in the anterior cerebral artery on unobstructed (contralateral) side. Patients with anterior communicating artery cross flow to the pericallosal artery (19%) had increased contralateral peak systolic velocity and mean anterior cerebral artery velocities. Patients without anterior communicating artery cross flow (18%) had normal peak velocities in the anterior and middle cerebral arteries. Patients with posterior communicating artery cross flow (42%) had ipsilaterally decreased peak systolic and mean middle cerebral artery velocities and increased peak velocities in the precommunicating posterior cerebral artery. Patients without posterior communicating artery cross flow (58%) had ipsilaterally decreased peak systolic and mean middle cerebral artery velocities. CONCLUSION Our findings suggest that typical abnormalities of basal cerebral artery flow velocities occur in patients with unilateral 70% to 100% obstruction of the internal carotid arteries resulting in different patterns of cross flow through the circle of Willis.
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Posterior cerebral artery
Anterior communicating artery
Posterior communicating artery
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[Purpose] The purpose of this study was to investigate the effects of action observation training (AOT) on cerebral hemodynamic changes including cerebral blood flow velocity (CBFV) and cerebral blood flow volume (CBFvol) in healthy subjects. [Subjects] Fifteen healthy subjects participated in this study. [Methods] All subjects were educated regarding AOT, and systolic peak velocity (Vs) as well as mean flow velocity (Vm) in the middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA) were evaluated using functional transcranial doppler with a 2-MHz probe, before and after performing AOT. [Results] Healthy subjects showed significant differences in Vs and Vm in the MCA, ACA, and PCA after AOT compared with those before AOT. [Conclusion] Our findings indicate that AOT has a positive effect in terms of an increase in CBFV and CBFvol in healthy subjects, since the brain requires more blood to meet the metabolic demand during AOT.
Transcranial Doppler
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Posterior cerebral artery
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Developmental vascular anomalies of brain are non-modifiable risk factors for the development of aneurysms and are prone for rupture. We report one such association in a 44–year-old gentleman who succumbed to subarachnoid hemorrhage (SAH) secondary to ruptured distal anterior cerebral artery aneurysm associated with vascular anomalies in the anterior and posterior circulation that included trifurcation of anterior cerebral artery and bilateral fetal posterior cerebral arteries. We identified multiple anomalies in circle of Willis that could have contributed to the formation of aneurysm and early rupture. Knowledge of these variations is essential to plan early and optimum management with close follow-up.
Anterior cerebral artery
Posterior cerebral artery
Circle of Willis
Anterior communicating artery
Posterior communicating artery
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