Original contribution
Transcranial doppler sonography: Anatomical landmarks and normal velocity values

https://doi.org/10.1016/0301-5629(90)90039-FGet rights and content

Abstract

Until recently, both the diagnosis of intracranial occlusive disease of the large brain arteries, as well as intracranial flow abnormalities due to extracranial arterial lesions, have been a “blind spot” for ultrasound techniques. With the advent of transcranial Doppler sonography (TCD), however, a broad spectrum of potential clinical and scientific applications of TCD to the intracranial vasculature has been advocated. In order to achieve an informative insonation of vessels and a correct interpretation of findings, knowledge of both anatomical landmarks within the skull and flow characteristics of distinct vessel segments are necessary. This paper presents such data elaborated from 64 carotid and 42 vertebral angiograms, 40 contrast-medium enhanced CT scans demonstrating the circle of Willis, 122 normal sagittal MRI scans of the brainstem, 40 cadaver skulls, 38 fresh cadavers, 106 normal volunteers and 59 patients with subclavian steal mechanisms. The main findings were as follows: The inner internal carotid artery bifurcation, the Ml-segment of the middle cerebral artery, the C3-segment of the carotid siphon, the vertebral artery junction and the top of the basilar artery were found at insonation depths of 60.4±7, 40±8 to 60.4±7, 62±4, 84±8 and 108±8 mm, respectively. Normal mean flow velocities within the Ml-segment, the posterior cerebral artery, the carotid siphon and the basilar trunk were 58±15.6, 39±9.9, 47±13.8 and 41±10 cm/s, respectively, and revealed a marked decrease with age. Intraindividual side-to-side differences were low. Vertebrobasilar data from measurements of neuroradiological material closely met in vivo findings in normals and patients. Criteria for the identification of various vessel segments are provided. On the basis of these findings, a topographical orientation within the skull should be possible in order that beginners commence TCD accurately. Normative velocity data are helpful for differentiating normal and pathological flow conditions at different ages.

References (22)

  • B.J. Arnolds et al.

    Transcranial Doppler sonography

  • S.S. Kety

    Human cerebral blood flow and oxygen consumption as related to aging

    J. Chronic Dis.

    (1956)
  • R. Aaslid et al.

    Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries

    J. Neurosurg.

    (1982)
  • R. Aaslid

    Visually evoked dynamic blood flow response of the human cerebral circulation

    Stroke

    (1987)
  • M. Edelmann et al.

    Transcranial Doppler sonography for monitoring of the middle cerebral blood flow velocity during carotid endarterectomy

    Rev. Bras. de Angiol. e Clint. Vasc.

    (1986)
  • T.O. Gabrielsen et al.

    Normal size of the internal carotid, middle cerebral and anterior cerebral arteries

    Acta Radiol.

    (1970)
  • A. Harders et al.

    Transcranial Doppler sonography and its application in extracranial-intracranial bypass surgery

    Neurol. Res.

    (1985)
  • J.G. Koritke et al.

    Atlas anatomischer Schnittbilder des Menschen. I

  • K.-F. Lindegaard et al.

    Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound

    J. Neurosurg.

    (1985)
  • E. Melamed et al.

    Reduction in regional cerebral blood flow during normal aging in man

    Stroke

    (1980)
  • J.M.F. Mol et al.

    Doppler haematotachographic investigation in cerebral circulation disturbances

  • Cited by (226)

    • Correlation between heart rate variability and cerebral autoregulation in septic patients

      2023, Autonomic Neuroscience: Basic and Clinical
      Citation Excerpt :

      Transcranial Doppler (TCD) was used to assess blood flow velocity (FV) in the left middle cerebral artery (MCA). Its probe was held in an adequate insonation angle (Ringelstein et al., 1990) by a fixing helmet; arterial blood pressure (BP) was recorded through invasive monitoring (in either the radial or femoral artery). While any change in hemodynamic or respiratory parameters were avoided, both signals were simultaneously recorded for at least 8 min using a Doppler Box (DWL Compumedics, Singen, Germany); two operators (AQC and IAC) performed all TCDs.

    View all citing articles on Scopus
    View full text