Table 3.
Diagnostic performance indicators of transcranial color-coded Doppler ultrasound (TCCD) for the detection of steno-occlusive disease in each of the 30 individual analyses.
| Author (s), Publication Year |
Ref. | TCCD Technique | Comparator | Site of Stenosis/Occlusion | Degree of Stenosis | Ultrasound Diagnostic Criteria | TTW Failure n or * n (%) | Sen (%) | Spec (%) | PPV (%) | NPV (%) | DA (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Baumgartner et al. (1999) | [19] | TCCD | DSA | Ant + Post circulation | ≥50% | PSV ≥ 220 MCA | * 280/2741 (10) | 100 | 97.4 | 100 | 100 | 97.4 |
| Baumgartner et al. (1999) | [19] | TCCD | DSA | Ant + Post circulation | <50% | PSV ≥ 155 MCA | * 280/2741 (10) | 92.1 | 90.3 | 92.1 | 93 | 91.3 |
| Bar et al. (2010) | [20] | ncTCCD + TCCD-UCA |
CTA | Ant + Post circulation | Occlusion | 1. PSV > 220 cm/s 2. absent flow signal + ant arteries visible |
5/45 (11) | 100 | 77.8 | 91.7 | 100 | 93.5 |
| Bar et al. (2010) | [20] | * TCCD | CTA | MCA main sterm | Occlusion | MCA flow signal absent + ant arteries visible | 5/45 (11) | 92.3 | 94.4 | 92.3 | 94.4 | 93.5 |
| Nasr et al. (2013) | [21] | ncTCCD | MRA | Ant + Post circulation MCA M1 (3), PCA P1 (1), VA (1), BA (1) |
≥50% stenosis (5) or occlusion (1) | 1.MCA M1 PSV = 220 cm/s, 2. ACA PSV = 155 cm/s 3. PCA P1 PSV = 145 cm/s, 4. BA PSV = 140 cm/s |
17/159 (10.7) | 100 | 100 | 100 | 100 | 100 |
| Schlachetzki et al. (2012) | [22] | ncTCCD (72) + CEUS TCCD (41) |
CTA, MRA | MCA | Occlusion | MFV-asymmetric index > 21%, absent flow | 11/113 (10) | 90 | 98 | 90 | 98 | 98 |
| Lange et al. (2015) | [23] | ncTCCD | DSA | Ant +Post circulation | ≥50−occlusion | Retrograde flow, vessel occlusion signals, or turbulent flow patterns |
11/65 (17) | 72.7 | 100 | 100 | 98.8 | 98.9 |
| Zunker et al. (2002) | [24] | CEUS TCCD | MRA | Ant +Post circulation | ≥50−occlusion | 1. MFV > 80 cm/s (MCA and ICA), 2. MFV > 75 cm/s—ACA), 3. MFV > 60 cm/s (PCA and VA), 4. MFV > 65 BA |
61 (8.8) | 83 | 82 | 83.3 | 82 | 83 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | <50% | PSV ≥ 110 | n/a | 90.3 | 80.6 | 94 | 71.4 | 88.1 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | 50−69% | PSV ≥ 150 | n/a | 94.3 | 97.9 | 98 | 94 | 96 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | 70−99% | PSV ≥ 210 | n/a | 77.1 | 98.2 | 94.5 | 91.2 | 92 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | <50% | MFV ≥ 70 | n/a | 87.4 | 87.1 | 95.8 | 67.5 | 87.3 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | 50−69% | MFV ≥ 90 | n/a | 93.8 | 95.9 | 96.1 | 93.4 | 94.8 |
| Yang et al. (2018) | [25] | cTCCD | DSA | BA | 70−99% | MFV ≥ 120 | n/a | 92.4 | 90.9 | 80.7 | 96.6 | 91.3 |
| Tateishi et al. (2008) | [26] | CEUS TCCD | DSA | BA | >50% | CEUS PSV > 120 cm/s | 6/120 (5) | 100 | 95 | 64 | 100 | 95 |
| Valaikiene et al. (2008) | [27] | TCCD | DSA | Terminal ICA | ≥70% | PSV > 200 cm/s | n/a | 71 | 100 | 100 | 95.8 | 96 |
| Kunz et al. (2006) | [28] | CEUS TCCD | DSA | Ant +Post circulation | >0% | increased MFV, retrograde flow, no signals, or turbulent flow patterns. | 7/164 (4) | 82 | 98 | 99 | 75 | 84 |
| Herzberg et al. (2014) | [29] | CEUS ncTCCD | CTA, MRA | MCA | MCA occlusion | MCA flow signal absent + ant arteries visible | 11/102 (11) | 90 | 98 | 90 | 98 | 97 |
| Tang et al. (2005) | [30] | TCCD | MRA | MCA | >50—near occlusion | PSV ≥ 140 cm/s or PSV < 40 cm/s | 17/193 (8.8) | 81.8 | 92.1 | 48.6 | 98.2 | 65.2 |
| Ogata et al. (2004) | [31] | cTCCD | DSA | MCA | MCA occlusion | EDV = 25 cm/s | n/a | 94 | 81 | 98 | 94 | |
| Ogata et al. (2005) | [38] | CEUS cTCCD | DSA | MCA | >50—MCA stenosis | PSV = 170 cm/s | n/a | 89 | 100 | 100 | 99 | 99.1 |
| Liu et al. (2021) | [41] | cTCCD | DSA | MCA | 50−69% | PSV ≥ 180 cm/s | 553/1471 (37) | 95.7 | 64 | 35.6 | 98.6 | 69.7 |
| Liu et al. (2021) | [41] | cTCCD | DSA | MCA | 70−99% | PSV ≥ 240 cm/s | 553/1471 (37) | 93.5 | 89.9 | 50.7 | 97.7 | 85.5 |
| Liu et al. (2021) | [41] | cTCCD | DSA | MCA | 50−69% | MFV ≥ 110 cm/s | 553/1471 (37) | 95.7 | 64 | 35.4 | 98.6 | 69.4 |
| Liu et al. (2021) | [41] | cTCCD | DSA | MCA | 70−99% | MFV ≥ 160 cm/s | 553/1471 (37) | 91.9 | 92.8 | 69.7 | 97.3 | 92.2 |
| Liu et al. (2023) | [39] | CEUS * TCCD | DSA | MCA | >0% | PSV ≥ 168.5 cm/s | 0/208 (0) | 89.2 | 94.7 | 39.3 | 80 | 97.7 |
| Liu et al. (2023) | [39] | CEUS * TCCD | DSA | MCA | >0% | MFV ≥ 110.5 cm/s | 0/208 (0) | 90.5 | 94.7 | 90.5 | 94.7 | 97.5 |
| Gerriets et al. (2002) | [40] | CEUS cTCCD | DSA, MRA, CTA | MCA | >0% | MFV > 120 cm/s, >21% side to side difference | 4/58 (7)—CEUS TCCD 32/58 (45)—TCCD |
n/a | n/a | n/a | n/a | 97 |
| Lien et al. (2001) | [32] | cTCCD | MRA | MCA | >0% | PSV ≥ 120 cm/s | * 89/240 (37) | 66.7 | 90.5 | 93.9 | 55.1 | 78.6 |
| Lien et al. (2001) | [32] | cTCCD | MRA | MCA | >0% | MFV ≥ 85 cm/s | * 89/240 (37) | 59.9 | 92.9 | 94.8 | 50.6 | 76 |
| Lien et al. (2001) | [32] | cTCCD | MRA | MCA | >0% | EDV ≥ 85 cm/s | * 89/240 (37) | 52.7 | 90.5 | 92.5 | 46.3 | 71.6 |
ncTCCD—transcranial color-coded Doppler ultrasound (no microbubble contrast); cTCCD—transcranial color-coded Doppler ultrasound (angle correction and no microbubble contrast), cTCCD—transcranial color-coded Doppler ultrasound (angle correction and no microbubble contrast); ncTCCD-UCA—transcranial color-coded Doppler ultrasound (no angle correction, with contrast); cTCCD-UCA—transcranial color-coded Doppler ultrasound (with angle correction and contrast), * TCCD—not clear whether angle correction was used; CTA—computed angiography, PMD-TCD—power motion mode transcranial Doppler ultrasound, MRA—magnetic resonance angiography, DSA-digital subtraction angiography, PSV-Peak systolic velocity (cm/s); S-N MFV ratio-stenotic to normal mean flow velocity ratio; MFV asymmetric index—mean flow velocity asymmetry index (ipsilateral and contralateral); na—not available; n—number of patients; * n—number of vessels. Sen—sensitivity; Spec—specificity; PPV—positive predictive value; NPV—negative predictive value; DA—diagnostic accuracy; TP—true positive; TN—true negative; FP—false positive; FN—false negative were calculated based on the given data on sensitivity, specificity, and the number of patients if not given [42]. *—indicates that the value is a calculated value; >0—distinguishing normal from any stenosis. MCA—middle cerebral artery; Ant + Post circulation—anterior and posterior circulation evaluated; BA—basilar artery, Dist ICA—distal internal carotid artery.
ncTCCD—transcranial color-coded Doppler ultrasound (no angle correction, no microbubble contrast); cTCCD—transcranial color-coded Doppler ultrasound (with angle correction, no microbubble contrast); ncTCCD-UCA—transcranial color-coded Doppler ultrasound (no angle correction, with microbubble contrast); cTCCD-UCA—transcranial color-coded Doppler ultrasound (with angle correction, with microbubble contrast); CEUS—contrast-enhanced ultrasound; * TCCD—not clear whether angle correction was used; CTA—computed tomography angiography, MRA—magnetic resonance angiography, DSA-digital sub-traction angiography, PSV-Peak systolic velocity (cm/s); MFV—mean flow velocity (cm/s); MFV asymmetric index—mean flow velocity asymmetry index (ipsi-lateral and contralateral); n/a—not available; n—number of patients; * n—number of vessels. Sen—sensitivity; Spec—specificity; PPV—positive predictive value; NPV—negative predictive value; DA—diagnostic accuracy [42]; TTW—transtemporal window; >0—distinguishing normal from any stenosis. MCA—middle cerebral artery; Ant + Post circulation—anterior and posterior circulation evaluated; ACA—anterior cerebral anterior; ICA—internal carotid artery; PCA—posterior cerebral artery; VA—vertebral artery; BA—basilar artery.