Transcranial and transcervical Doppler ultrasound for the diagnosis of cerebrovascular disease and vertigo: a comprehensive systematic review

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BACKGROUND: Vertigo can stem from various causes, including central nervous system disorders and vascular issues. Nearly 10% of strokes go undiagnosed during initial hospital visits. CT angiography and MR angiography currently represent the gold standard in diagnosing cerebrovascular ischemic pathology but have limitations in early diagnosis. In this context, Doppler ultrasound emerges as a safer, non-invasive option for diagnosing cerebrovascular conditions.METHODS: A systematic review was conducted between December 2023 and January 2024. It was conducted in accordance with PRISMA 2020 guidelines. English-, Italian-, or German-language studies published from 2014 onward with a cohort of at least 10 patients with acute vertigo who underwent Doppler ultrasound examination of the neck and/or skull were included. Two independent reviewers performed the screening, selection, and compliance assessment of the study.RESULTS: A total of 147 articles were identified from the database search process. Of these, 125 articles were excluded during the screening phase. Subsequently, 19 articles were read in full and evaluated for study eligibility. Once articles that did not conform to the research objective were excluded, 6 original studies published between 2014 and 2022 were included. The ultrasound examination was performed in various modalities: exclusive extracranial study, intra- and extracranial study, exclusive intracranial study, transcranial study. All studies employed at least one of the classical imaging techniques (computed tomography, magnetic resonance imaging, MR angiography, or diffusion-weighted MRI imaging) to compare the outcome.CONCLUSIONS: The use of Doppler ultrasound for cerebrovascular pathology is not yet standardized in the literature. However, preliminary results are promising and suggest a potential role of transcranial Doppler ultrasound and extracranial Doppler as additional methods in the evaluation of patients with vertigo syndrome and acute cerebrovascular pathology, showing intermediate sensitivity but extremely high specificity.

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