Transcranial color-coded duplex sonography in the evaluation of collateral flow through the circle of Willis.

PURPOSE To determine the sensitivity, specificity, and positive and negative predictive values of transcranial color-coded duplex sonographic (TCCD) evaluation of cross flow through the anterior (ACoA) and posterior (PCoA) communicating arteries in patients with occlusive cerebrovascular disease.

METHODS We studied prospectively 132 patients (37 women, 95 men; mean age, 60 years) with stenoses of more than 69% reduction in vessel diameter (n = 93) and occlusions (n = 52) of the internal carotid artery, and three occlusions of the basilar artery. The sonographer was aware of extracranial sonographic findings but was blinded to the results of cerebral angiography.

RESULTS Nine patients (7%) with thick bones preventing transtemporal insonation and three patients (3%) with occlusions of the middle (n = 3) and anterior (n = 1) cerebral arteries were excluded. Sensitivity of TCCD for detection of collateral flow through the ACoA in patients with occlusive carotid artery disease was 98%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 98%. The corresponding values for the PCoA were 84%, 94%, 94%, and 84%, respectively. All three functional PCoAs were identified in patients with occluded basilar arteries.

CONCLUSION TCCD is a valuable method for noninvasive evaluation of cross flow through the ACoA in patients with adequate sonographic windows. However, TCCD evaluation of cross flow through the PCoA is less reliable, because hemodynamic criteria may cause falsely positive and falsely negative results.