Vertebral Artery Doppler Reference Values in Healthy Turkish Adults: Influence of Age, Sex, and BMI

Q: What are the key findings of this study?

Vertebral artery Doppler ultrasonography in healthy Turkish adults showed left-sided dominance in diameter (3.73 vs 3.52 mm, p<0.001) and a normal total flow volume range of 124.7-391.8 mL/min.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Healthy adults undergoing vertebral artery Doppler ultrasonography (n=223). Intervention: Age, sex, body mass index (BMI), and vessel laterality (left vs. right vertebral artery) vs. Contralateral side and demographic/anthropometric strata. Primary outcome: Vertebral artery diameter (mm), left vs. right side (MD 0.21 mm, p=<0.001).

Q: What does this research mean for the field?

Vertebral artery Doppler ultrasonography in healthy Turkish adults demonstrates left-sided dominance in caliber and velocity, with a normal total flow volume range of 124.7 to 391.8 mL/min that falls below conventional diagnostic cutoffs. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

To establish population-specific bilateral Doppler reference values for vertebral artery diameter, blood flow velocities, indices, and flow volume in healthy adults, while assessing the influence of age, sex, laterality, and body mass index.

Ahmet Tuğrul Akkuş; Muhammed Furkan Barutcigil; Said Ali Atalay

doi:10.4274/abcr.2026.26461

October 28, 2026Archives of Basic and Clinical ResearchOpen Access

Vertebral Artery Doppler Reference Values in Healthy Turkish Adults: Influence of Age, Sex, and BMI

View Full Paper

Ask AI

Bookmark

Share

Key result

Vertebral artery Doppler shows left-sided dominance with ~0.2-mm greater diameter in healthy adults.

MD +0.21 mm
P<0.001
n=223

Why the study?

Population-specific bilateral reference values for vertebral artery Doppler ultrasonography parameters in healthy Turkish adults, and the effects of age, sex, laterality, and BMI on these parameters, needed to be established.

Key Points

To establish population-specific bilateral Doppler reference values for vertebral artery diameter, blood flow velocities, indices, and flow volume in healthy adults, while assessing the influence of age, sex, laterality, and body mass index.
Prospective multicenter study conducted across three independent centers enrolling 223 healthy Turkish adults (mean age 39.4 ± 12.2 years; 140 women, 83 men).
Standardized vertebral artery Doppler ultrasonography was performed to measure vessel diameter, peak systolic velocity, end-diastolic velocity, resistive index, pulsatility index, and flow volume, with complete Doppler datasets analyzed in 222 participants.
Left vertebral arteries displayed significant left-sided dominance, with larger mean diameter (3.73 ± 0.57 mm vs. 3.52 ± 0.61 mm; P < 0.001), peak systolic velocity (49.6 ± 13.9 vs. 47.4 ± 14.2 cm/s; P = 0.03), end-diastolic velocity (16.4 ± 6.0 vs. 14.5 ± 6.3 cm/s; P < 0.001), and flow volume (126.8 ± 61.0 vs. 107.6 ± 51.3 mL/min; P < 0.001) compared to the right.
Males had larger median right vertebral artery diameters (3.70 mm vs. 3.50 mm; P = 0.004) and higher resistive and pulsatility indices bilaterally, whereas females had higher right end-diastolic velocity (14.25 vs. 13.11 cm/s; P = 0.037).
Total vertebral artery flow volume reference range (5th to 95th percentile) was 124.7 to 391.8 mL/min, demonstrating that the conventional clinical threshold of 200 mL/min for vertebrobasilar insufficiency lies substantially above the 5th percentile.

Study Design

Type

Cross-Sectional (n=223)

Multicenter

Yes

Structured PICO

P

Population

223 healthy Turkish adults (mean age 39.4 years, 62.8% female, BMI <=40 kg/m2) free of neurological, cerebrovascular, or cervical spine disease evaluated across three centers.

E

Exposure

Vertebral artery color Doppler ultrasonography performed using a standardized protocol

O

Outcome

Bilateral reference values (5th to 95th percentiles) for vertebral artery diameter, peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and flow volumesurrogate

Main Result

Mean Difference: 0.21

Absolute Event Rate: 3.73% vs 3.52%

p-value: p=<0.001

Limitations

One center enrolled a significantly older subgroup (mean age 42.8 vs. 38.0-38.3 years), introducing potential inter-center heterogeneity.
Individuals with morbid obesity (BMI >40 kg/m2) were excluded, limiting generalizability across the full obesity spectrum.
Doppler measurements were not validated against an independent reference imaging modality such as CTA or MRA.
Inter-rater and intra-rater reliability were not formally assessed across the three centers.
The cross-sectional design precludes causal inference regarding the effects of age or BMI on vertebral artery hemodynamics.
Heart rate and blood pressure were not recorded at the time of examination, which may have confounded resistive and pulsatility indices.
Small sample sizes in older age strata (n=29-30 in 50-59 years and n=16-17 in >=60 years) resulted in imprecise 5th and 95th percentile estimates.
One center enrolled an older subgroup (mean age 42.8 vs. 38.0-38.3 years), which may have introduced heterogeneity.
Excluded individuals with BMI >40 kg/m², limiting generalizability across the full obesity spectrum.
Did not validate Doppler measurements against an independent imaging modality (e.g., CTA or MRA).
Inter-rater and intra-rater reliability were not formally assessed.
Cross-sectional design precludes causal inference about the effects of age or BMI on vertebral artery hemodynamics.
Heart rate and blood pressure were not recorded at the time of the examination.
Some age strata were small (n=16-17 in the ≥60 group and n=29-30 in the 50-59 group), making percentile estimates imprecise.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This multicenter study establishes sex- and age-stratified reference values for vertebral artery Doppler ultrasonography in healthy Turkish adults and demonstrates that the 5th percentile for total flow volume (124.7 mL/min) is well below the traditional 200 mL/min threshold for vertebrobasilar insufficiency.

Abstract

Objective: To establish population-specific bilateral reference values for vertebral artery (VA) diameter, peak systolic velocity (PSV), enddiastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and flow volume in healthy Turkish adults, and to assess the effects of age, sex, laterality, and body mass index (BMI) on these parameters.Methods: This prospective, multicenter study enrolled 223 healthy Turkish adults from three centers.VA Doppler ultrasonography was performed using a standardized protocol.The measured parameters included VA diameter, PSV, EDV, RI, PI, and flow volume.Results: Left vertebral arteries exhibited significantly larger diameter (3.73 ± 0.57 mm vs. 3.52 ± 0.61 mm), PSV, EDV, and flow volume compared to the right side (P < 0.05).Males had a larger right VA diameter and higher RI and PI bilaterally, whereas females had higher right VA EDV (P < 0.05).Age was negatively correlated with PSV, RI, and PI, but positively correlated with left VA diameter.BMI was negatively correlated with PSV, RI, and PI, but did not significantly affect flow volume.Reference percentiles were established based on sex and age.Conclusion: This study investigated normal reference values for six VA Doppler parameters in 223 healthy Turkish adults, stratified by sex and age, with BMI evaluated as a covariate.It is the first study to include BMI as a covariate and to derive percentile-based norms from a multicenter Turkish cohort.The normal range (5 th -95 th percentile) for total VA flow volume was 124.7-391.8mL/min.Because this lower limit lies well below the widely quoted 200 mL/min threshold for vertebrobasilar insufficiency, applying that threshold would misclassify a considerable proportion of healthy adults as abnormal.These findings support improved clinical interpretation of VA Doppler ultrasonography.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Akkuş et al. (2026) conducted a cross-sectional in Healthy adults undergoing vertebral artery Doppler ultrasonography (n=223). Age, sex, body mass index (BMI), and vessel laterality (left vs. right vertebral artery) vs. Contralateral side and demographic/anthropometric strata was evaluated on Vertebral artery diameter (mm), left vs. right side (MD 0.21 mm, p=<0.001). Vertebral artery Doppler ultrasonography in healthy Turkish adults showed left-sided dominance in diameter (3.73 vs 3.52 mm, p<0.001) and a normal total flow volume range of 124.7-391.8 mL/min.

synapsesocial.com/papers/6ae584b44c46c197bbab27ae https://doi.org/10.4274/abcr.2026.26461

View Full Paper

Ask AI

Bookmark

Share

Vertebral Artery Doppler Reference Values in Healthy Turkish Adults: Influence of Age, Sex, and BMI

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Vertebral Artery Doppler Reference Values in Healthy Turkish Adults: Influence of Age, Sex, and BMI

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading