Transcranial Doppler

Principle of the percutaneous Doppler sonography

The source transducer in the probe transmit ultrasound wave at f 0 , while the receiving
transducer receives the wave at f1 that have been black scattered from the RBC moving at
velocity V.

90

75

60
Relative
error
45
100% 74%
50% 30
29%
13%
3% 15

0%
V
Tertiary effects: collateral channels

1. Increased velocity and decreased pulsatility, turbulence at

branch points
2. Systolic deceleration, alternating flow, reversed flow direction,
PI often depends on the resistance of the vascular bed in the
supplied territory
 Velocity component measured by the Doppler principle is always
lower than the real flow velocity

For insonation angle  the

measured velocity is Vcos
V  Seldom will insonation 
exceed 30°. It’s cosine would
Vcos
vary between 1 and 0.86
(.ie. Maxi error is 15%)

On the other sides, flow velocity affected by

1. causes that change cerebral blood flow (CBF)
2. vessel diameter
Orbital Windows

• ICA siphon can be found at a depth of

55 to 70mm
1. Parasellar portion
2. Genu portion
3. Supraclinoid portion

• 4. OA is sought at depth at 40 to 50mm

towards the probe and relatively high
pulsatility, it serves as a source of collateral
flow in the presence of significant carotid
artery disease

• Acoustical intensity 10-17% of its

maximum
MCA stenosis- left distal severe stenosis

Vs=80cm/sec Vs=330cm/sec
• Spencer(1990) reported “ signals
designating emboli”--HITS

• 1- hour on-line monitoring to capture

these signals, HITs can be artefects

• Usually have a harmonic

quality”chirop” and unidirectional and
within the doppler flow spectrum

• Multi-depth and multi-frequency

approach
Carotid Screening
 Scanning Technique

• All arteries should be scanned using appropriate gray scale and Doppler
techniques and

• Proper patient positioning.

• Color Doppler imaging should be used to detect areas of narrowing and

abnormal flow to select areas for spectral analysis

• Color Doppler should be used to clarify the cause of image/pulsed Doppler

mismatches and to detect narrow flow channels at sites of stenosis.
 Recording

1. Grayscale: At a minimum, for each normal side evaluated, grayscale

images must be obtained at each of the following levels:
a. Long axis of common carotid artery;
b. Long axis, at the carotid artery bifurcation;
c. Long axis of internal carotid artery to include its origin;
and
d. Short axis of proximal internal carotid artery
 Recording 2
2. Color Doppler: At a minimum, for each normal side evaluated, color
Doppler images

a. Long axis of distal common carotid artery;

b. Long axis of proximal and midinternal carotid artery;

c. Long axis of external carotid artery (with identification

of a branch if possible); and

d. Long axis of vertebral artery

 Recording 3
3. Spectral Doppler: For each normal side evaluated, spectral Doppler waveforms and
maximal peak systolic velocities must be recorded at each of the
following levels:

a. Proximal common carotid artery;

b. Middle or distal common carotid artery (2–3 cm below the

bifurcation);

c. Proximal internal carotid artery;

d. Mid to distal cervical internal carotid artery;

e. Proximal external carotid artery; and

f. Vertebral artery (in neck or near origin).