# Getting to the heart of Carotid and Vertebral imaging in acute ischemic stroke: an all-encompassing cross-sectional comparative analysis of Colour Doppler Ultrasound, CT Angiography, and MR Angiography

## TL;DR

This study compares three imaging techniques for detecting artery issues in stroke patients, finding that CT and MR angiography are more effective than ultrasound.

## Contribution

The study provides a comprehensive cross-sectional comparison of CDUS, CTA, and MRA for acute stroke imaging.

## Key findings

- CTA and MRA showed higher sensitivity for defining stenosis and plaques compared to CDUS.
- Good agreement (kappa > 0.6) was found between CTA and MRA in plaque detection.
- CDUS lacks sensitivity in identifying vulnerable plaques, especially in vertebral arteries.

## Abstract

This study presents a comprehensive comparison of minimally-invasive extracranial neck imaging modalities—Colour Doppler ultrasound (CDUS), CT angiography (CTA), and MR angiography (MRA)—in acute ischaemic stroke (AIS) patients. The aim was to evaluate vessel stenosis, its related parameters, and assess the role of early CTA/MRA in AIS.

Categorical and continuous data were compared with Chi-square and independent Sample t-test, respectively. Spearman rank correlation matrix was performed for non-linear CDUS variables. The agreement between various imaging modalities was calculated with kappa (k) coefficient.

AIS was most common in males, aged 61-70 years, associated with hypertension and smoking (P-value < .05). Seventy-four plaques were identified in 50 patients, with good agreement between the 3 imaging (k > 0.6). CDUS was limited in evaluating Vertebral Arteries and plaque characterization. CTA/MRA showed higher sensitivity for defining stenosis and plaques, with good-excellent agreement between them (k > 0.6). CTA and MRA identified 40 and 43 vulnerable plaques, respectively.

Colour Doppler ultrasound is subjective, comprehensive assessment of anatomic and hemodynamic parameters but lacks sensitivity in identifying vulnerable plaques. CTA/MRA have better sensitivity with good soft tissue differentiation especially in lesser stenosed vessels.

Our results support preferred use of MRA/CTA as first-line modalities in time-sensitive scenarios like acute stroke and need to move beyond CDUS-based assessment. These show promise in detecting vulnerable plaque and predicting AIS risk/recurrence; in patient triage, and to guide early intensive treatment. Longitudinal studies are required to assess risk reduction by early advanced imaging.