A Comparative Study of Carotid Doppler and Magnetic Resonance Angiography Neck Vessels in Stroke Patients

Abstract

Introduction: According to the definition provided by the World Health Organization, stroke is delineated as a clinical syndrome characterized by the rapid onset of observable clinical indicators indicative of either localized or widespread disruption in cerebral function, enduring for a duration exceeding 24 hours. The study aimed to evaluate the positive findings of color Doppler and MRA in neck vessels in stroke patients and to delineate the pitfalls during imaging, interpretations and limitations of color Doppler ultrasound.

Material and Methods: A prospective observational study was conducted in the Radiodiagnostic Department of SRMSIMS hospital in Bareilly, India. Over a period of 1.5 years in the Department of Radiodiagnosis. The study included a total of 60 patients with a history of stroke and coming for ultrasound carotid Doppler is further evaluated using MRA to determine stenosis or occlusion of carotid artery and assessed using Acuson Siemens Juniper Ultrasound, 3 Tesla 48 Channel MRI Machine Seimens Magnetom Skyra and 1.5 Tesla 16 Channel MRI Machine Seimens Magnetom Sempra.

Results: The study shows that the 60 stroke patients aged 58.43 ± 13.25 years, comprised 78.33% males and 21.67% females. Presenting complaints of 28.33% with right-sided paralysis, 20% with left-sided paralysis and bilateral lower limb weakness (13.33%). About 55% had right-sided strokes and 45% had left-sided strokes. For right-sided strokes, Doppler identified mild stenosis in 11.11% of cases, whereas MRA detected 6.06%. Statistical analysis revealed no significant difference in between Doppler (p = 0.610) and MRA (p = 0.552) for mild stenosis. MRA detected additional cases of mild to severe stenosis not identified by Doppler (p > 0.05). Among left-sided stroke patients, Doppler identified mild stenosis in 12.12%, slightly less than the 15.15% detected by MRA, with a non-significant p-value of 0.72 indicating comparable performance in mild stenosis detection. For internal carotid artery (ICA) stenosis, Doppler and MRA demonstrated differing capabilities. Doppler identified mild stenosis in 14.81 and 6.06% of right and left stroke patients, respectively, while MRA detected similar patterns in 14.81 and 7.41% of cases. Both modalities exhibited high agreement in detecting the absence of stenosis (p >0.05). Doppler showed notable differencesbetween right and left stroke patients, whereas MRA depicted more consistent findings across both sides in the assessment of plaque nature. Doppler detected hypoplastic vertebral artery (VA) in 15.15% of right-sided strokes and 6.06% for left-sided strokes, MRA identified higher rates at 21.21 and 18.18%, respectively, with non-significant differences (p > 0.05). MRA significantly outperformed Doppler in detecting diffuse VA involvement (22.22 vs. 0% in right-sided strokes, p = 0.005; and 0 vs. 77.78% in left-sided strokes, p = 0.000) and in identifying the absence of abnormalities (p = 0.002 and p = 0.000 for right and left VA, respectively).

Conclusion: This study concluded that MRA tended to detect more cases of stenosis across various severity levels compared to Doppler, particularly in severe stenosis among left-sided stroke cases, however, the differences were not statistically significant. MRA significantly outperformed Doppler in detecting diffuse vertebral artery involvement. This shows the complementary roles of Doppler and MRA in assessing CCA and ICA stenosis, MRA tends to offer a marginal advantage due to its superior resolution and ability to detect subtle abnormalities such as minor calcifications.