Transcranial Doppler pulsatility indices as a measure of diffuse small-vessel disease

J Neuroimaging. 2001 Jul;11(3):229-35. doi: 10.1111/j.1552-6569.2001.tb00039.x.


Background and purpose: Elevation in pulsatility indices (PIs) as measured by transcranial Doppler (TCD) have been postulated to reflect downstream increased vascular resistance caused by small-vessel ischemic disease.

Methods: The authors retrospectively compared TCD PIs and magnetic resonance imaging (MRI) manifestations of small-vessel disease in 55 consecutive patients who underwent TCD studies and brain MRI within 6 months of each other during a 2-year period.

Results: Correlations between TCD middle cerebral artery PIs and MRI measures were as follows: periventricular hyperintensity (PVH) = 0.52 (P < .0001), deep white matter hyperintensity (DWMH) = 0.54 (P < .0001), lacunar disease = 0.31 (P = .02), and combined PVH/DWMH/lacunes = 0.54 (P < .0001). Correlation between pontine ischemia and vertebrobasilar PIs was 0.46 (P = .0004). Univariate analysis showed that age, elevated PI, and hypertension strongly correlated with white matter disease measures. After adjusting for these factors in a multivariate Poisson regression analysis, PI remained an independent predictor of white matter disease. Receiver operator curve analyses identified PI cut points that allowed discrimination of PVH with 89% sensitivity and 86% specificity and discrimination of DWMH with 70% sensitivity and 73% specificity.

Conclusions: Elevation in PIs as measured by TCD shows strong correlation with MRI evidence of small-vessel disease. TCD may be a useful physiologic index of the presence and severity of diffuse small-vessel disease.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / pathology
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Poisson Distribution
  • Pulsatile Flow
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Ultrasonography, Doppler, Transcranial*
  • Vascular Resistance