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

Abstract Objectives 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 ischemic stroke (AIS) patients. The aim was to evaluate vessel stenosis, its related parameters and assess the role of early CTA/MRA in AIS. Methods 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. Results AIS was most common in males, aged 61-70 years, associated with hypertension and smoking (p-value 0.05). 74 plaques were identified in 50 patients, with good agreement between the three imaging (k 0.6). CDUS was limited in evaluating VA 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 forty and 43 vulnerable plaques respectively. Conclusions CDUS 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. Advances in knowledge 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.