Frontiers in Medical Science Research, 2025, 7(6); doi: 10.25236/FMSR.2025.070607.
Hao Xu1, Lei Yang3, Yamei Wang2, Qiang Tu2
1The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, China
2Department of Neurology, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, China
3Department of Neurosurgery, The First Affiliated Hospital of Yangtze University, The First People's Hospital of Jingzhou, Jingzhou, China
Cerebrovascular diseases (CVDs) are among the most prevalent disorders in the field of neurology. Given their high incidence and mortality rates, the accurate assessment of cerebral arterial hemodynamics is of crucial significance for the diagnosis and treatment of CVDs. Transcranial Doppler Ultrasound (TCD) is a non-invasive diagnostic modality for the detection of CVDs. Currently, the main application aspects of TCD in CVDs include the precise identification of diseased blood vessels, the evaluation of collateral circulation efficiency, and the investigation of cerebral blood flow autoregulation function. However, relatively few studies have been conducted on cerebral blood flow autoregulation function. This study primarily demonstrates that TCD and digital subtraction angiography (DSA) exhibit good consistency in the detection of intracranial collateral circulation patency, and that cerebral vascular hemodynamics is positively correlated with the degree of cerebral vascular stenosis. Meanwhile, in ischemic cerebrovascular disease (ICVD), the decrease in mean flow velocity (Vm) and the increase in pulsatility index (PI) in the vertebral artery and basilar artery can serve as potential evaluation indicators for this disease. The combination of TCD and color Doppler ultrasound enables more accurate assessment of the degree of vascular stenosis. The consistency of sensitivity, specificity, and accuracy between TCD combined with carotid artery ultrasound (CUS) and cerebral angiography in the diagnosis of transient ischemic attack (TIA) is relatively high. Meanwhile, the derived Breath-Holding Index (BHI, %/s) can be utilized as a risk assessment indicator for vascular cognitive impairment (VCI).
Transcranial Doppler Ultrasound, Cerebrovascular Disease, Vascular Stenosis or Occlusion, Collateral Circulation, Cerebral Blood Flow Autoregulation Function
Hao Xu, Lei Yang, Yamei Wang, Qiang Tu. The Application Value of Transcranial Doppler Ultrasound in Cerebrovascular Diseases. Frontiers in Medical Science Research (2025), Vol. 7, Issue 6: 58-69. https://doi.org/10.25236/FMSR.2025.070607.
[1] Hakimi R, Alexandrov A V, Garami Z. Neuro-ultrasonography[J]. Neurologic Clinics, 2020, 38(1): 215-229.
[2] Blanco P, Abdo-Cuza A. Transcranial doppler ultrasound in neurocritical care[J]. Journal of Ultrasound, 2018, 21(1): 1-16.
[3] Mattioni A, Cenciarelli S, Eusebi P, et al. Transcranial doppler sonography for detecting stenosis or occlusion of intracranial arteries in people with acute ischaemic stroke[J]. The Cochrane Database of Systematic Reviews, 2020, 2020(2).
[4] Khawaja A M, Mcnulty J, Thakur U V, et al. Transcranial doppler and computed tomography angiography for detecting cerebral vasospasm post-aneurysmal subarachnoid hemorrhage[J]. Neurosurgical Review, 2022,46: 3.
[5] Aaslid R, Markwalder T M, Nornes H. Noninvasive transcranial doppler ultrasound recording of flow velocity in basal cerebral arteries[J]. Journal of Neurosurgery, 1982, 57(6): 769-774.
[6] Qi L X, Li Z R, Yao Y, et al. Predictive value of quantitative EEG combined with transcranial doppler ultrasound on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhages[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2022, 30(4): 99-103.
[7] Schenck H, Van C C, Van K S, et al. Systematic review and meta-analysis of transcranial doppler biomarkers for the prediction of delayed cerebral ischemia following subarachnoid hemorrhage[J]. Journal of Cerebral Blood Flow & Metabolism, 2025, 45(6): 1-17.
[8] Zheng Z. The application of TCD in monitoring changes in blood flow after detecting cerebral vascular stenosis[J]. Life Science Instruments, 2024, 22(6): 38-40.
[9] Ma X R. A study on the value of transcranial doppler ultrasonography to assess the effect of collateral circulation on cerebral blood flow in patients with severe middle cerebral artery stenosis[J]. Chinese Journal of Modern Drug Application, 2022, 16(20): 73-75.
[10] Xie P, Shen Y F, Shi Y Q, et al. Transcranial doppler in the diagnosis and prognostic evaluation of cranial collateral circulation after severe stenosis or occlusion of unilateral internal carotid artery[J]. Chinese Journal of Practical Nervous Diseases, 2022, 25(6): 717-722.
[11] Connolly F, Röhl J E, Lopez P J, et al. Pattern of activated pathways and quality of collateral status in patients with symptomatic internal carotid artery occlusion[J]. Cerebrovascular Diseases, 2019, 48(3-6): 244-250.
[12] Saqqur M, Khan K, Derksen C, et al. Transcranial doppler and transcranial color duplex in defining collateral cerebral blood flow[J]. Journal of Neuroimaging, 2018, 28(5): 455-476.
[13] Fang M X, Hui P J, Sun T, et al. Clinical significance of transcranial doppler ultrasonography to evaluate intracranial collateral circulation in patients with extracranial segment of unilateral internal carotid artery occlusion[J]. Journal of Apoplexy and Nervous Diseases, 2022, 39(1): 12-17.
[14] Kim Y S, Meyer J S, Garami Z, et al. Flow diversion in transcranial doppler ultrasound is associated with better improvement in patients with acute middle cerebral artery occlusion[J]. Cerebrovascular Diseases, 2006, 21: 74-78.
[15] Bai J P, Liu J Q, Gao R J. A comparative study of transcranial doppler ultrasound in diagnosing cerebral artery stenosis versus cerebral angiography[J]. Inner Mongolia Medical Journal, 2024, 56(9): 1095-1098.(in Chinese)
[16] Yu Z Y. Clinical value of intracranial doppler in diagnosis of intracranial vascular stenosis[J]. China Medical Device Information, 2022, 28(23): 87-89.
[17] Wu S S. The clinical diagnostic value of transcranial doppler ultrasound combined with color doppler ultrasound in cervical artery stenosis[J]. Journal of Imaging Research and Medical Applications, 2024, 8(11): 182-187.(in Chinese)
[18] Dai F, Yang J S, Qin L T, et al. Comparative study on reliability of CT and MRI in evaluating Hill Sachs Lesions[J]. Journal of Clinical Orthopedics and Research, 2021, 6(6): 350-354.
[19] An X Y. Observation on the value of combined diagnosis of ischemic stroke by carotid artery ultrasound and transcranial doppler ultrasound[J]. Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine, 2022, 10(6).(in Chinese)
[20] Chen Z, Yang Y G. Guidelines for the diagnosis and treatment of carotid artery stenosis[J]. Chinese Journal of Vascular Surgery (Electronic Version), 2017, 9(3): 169-175.(in Chinese)
[21] Ma X R. Study on the diagnostic value of transcranial doppler ultrasound combined with cervical vascular color doppler ultrasound in the diagnosis of patients with ischemic stroke[J]. Chinese Journal of Modern Drug Application, 2023, 17(4): 80-82.
[22] Xiao H P, Liu H L, Huang M, et al. Value of TCD in detecting hemodynamic parameters of intracranial artery in patients with severe extracranial stenosis of internal carotid artery[J]. Chinese Journal of Practical Nervous Diseases, 2023, 26(10): 1244-1248.
[23] Li L, Song B B, Duan Z H, et al. Value of transcranial doppler in the assessment of haemodynamic changes in the middle cerebral artery and collateral circulation[J]. Henan Medical Research, 2024, 33(16): 2980-2983.
[24] Zheng Y Y, Hui P J, Han J L, et al. Feasibility analysis of using transcranial doppler to semi-quantify collateral circulation of unilateral internal carotid artery with severe stenosis or occlusion[J]. Journal of Apoplexy and Nervous Diseases, 2018, 35(9): 782-786.
[25] Huang Y, Zhang S, Xue S H. Diagnostic value of transcranial doppler in establishment of collateral circulation in extracranial segment of internal carotid artery[J]. Chinese Journal of School Doctor, 2021, 35(12): 929-934.
[26] Chen Y, Zhao W F, Liu Q. Application value of carotid ultrasound combined with transcranial doppler ultrasound in ischemic cerebrovascular disease[J]. Journal of Medical Information, 2023, 36(13): 119-122.
[27] Hu L G, Zhao R J, Guo L L, et al. Application value of combined use of carotid color doppler and TCD in ischemic cerebrovascular disease[J]. Life Science Instruments, 2022, 20(S1): 31-32.(in Chinese)
[28] Chen J. Efficiency of transcranial doppler ultrasound combined with carotid ultrasound in diagnosis of ischemic stroke[J]. Medical Journal of Chinese People's Health, 2024, 36(19): 119-121.
[29] Xiong Y Z. Value of transcranial doppler and cervical vascular ultrasound in the diagnosis of acute ischemic stroke[J]. The Medical Forum, 2023, 27(4): 76-78.
[30] Shen F Q, Ma X L, Qiu Y, et al. Diagnostic value of carotid contrast-enhanced ultrasound and transcranial doppler ultrasound for ischemic stroke[J]. Smart Healthcare, 2023, 9(25): 1-4.
[31] Zhou F. The value of TCD combined with carotid artery ultrasound in the evaluation of intracranial and extracranial vessels in patients with ischemic stroke[J]. Journal of Imaging Research and Medical Applications, 2023, 7(4): 115-117.(in Chinese)
[32] Zhou J, Shan Y, Hu P. A systematic review and meta-analysis on transcranial doppler in diagnosing ischemic cerebrovascular disease[J]. Annals of Palliative Medicine, 2021, 10(8): 8963-8971.
[33] Li L Y, Li H B, Cao Q. Value of TCD combined with carotid color doppler ultrasonography in the diagnosis of transient ischemic attack[J]. China Medical Device Information, 2022, 28(18): 100-102.
[34] Ban D J, Sun Y G, Zhang J R. Clinical value of carotid ultrasound combined with transcranial doppler for the diagnosis of transient ischemic attack[J]. World Journal of Complex Medicine, 2024, 10(5): 183-185.
[35] Chen Y P. Relationship between cervical vascular ultrasound combined with transcranial doppler ultrasound and degree of carotid artery stenosis in acute cerebral infarction and analysis of prognostic factors[J]. China Medical Device Information, 2023, 29(10): 7-16.
[36] Lei H, Zeng G L, Zhu M L. Value of transcranial doppler sonography and ambulatory electroencephalography on evaluating short-term prognosis of patients with severe acute cerebral infarction[J]. Chinese Journal of Practical Nervous Diseases, 2023, 26(8): 947-952.
[37] Liu Y Y, Yi X Y, Cai Z H. Evaluation of early neurological deterioration and follow-up of modified rankin score in patients with acute stroke[J]. Chinese Community Doctors, 2017, 33(30): 34-37.
[38] Gao Y. The clinical value of transcranial doppler ultrasound in evaluating changes in cerebral blood flow parameters[J]. Journal of Imaging Research and Medical Applications, 2022, 6(23): 81-83. (in Chinese)
[39] Xu Y, Jin F F, Zhao L, et al. Analysis of difference value in NIHSS score and blood pressure before and after intravenous thrombolysis in the prediction of hemorrhage transformation in acute ischemic stroke patients[J]. Anhui Medical and Pharmaceutical Journal, 2021, 25(2): 250-254.
[40] Wang P, Ding J, Huang J K, et al. Application and observation study of transcranial doppler ultrasound for cerebral hemodynamic monitoring in the cognitive function assessment of patients with acute cerebral infarction[J]. Journal of Clinical Internal Medicine, 2023, 40(8): 559-560.(in Chinese)