The role of ultrasound screening in the diagnosis of small vessel disease

Abstract

Objective — to assess the diagnostic value of ultrasound screening in small vessel disease. Materials and methods. The study was carried out on the clinical bases of the Department of Therapeutic Disciplines of Black Sea National University named after Petro Mohyla (Odesa, Mykolaiv) from 2020 to 2022. A high-field 1.5 T MRI (Siemens Symphony, Germany) was used for verification. The presence of focal brain white matter lesions was assessed on axial T2-weighted and FLAIR sequences using the Fazekas, Scheltens, and Koedam scales. Cognitive functions were assessed using the MMSE scale. All patients underwent Doppler imaging of cerebral vessels using a Toshiba Aplio 500 device (Japan). As a control, 30 individuals of the same age without signs of SVD were examined. Statistical processing was carried out using methods of dispersion and correlation analysis with Statistica 14.0 software (TIBCO, USA). Results. All patients in the main group exhibited a moderate decrease in cognitive abilities, with an MMSE score of (23.5 ± 0.4) points (in the control group — (26.7 ± 0.5) points, p < 0.05). When evaluating the results of the MRI study, phenomena of leukoencephalopathy were observed in all patients. In 9 (19.6 %) patients, stage I according to Fazekas was determined, in 22 (47.8 %) — stage II, and in 15 (32.6 %) — stage III according to Fazekas. For comparison, in the control group, only 4 (13.3 %) had minimal signs of leukoencephalopathy (grade I according to Fazekas). Atrophy of the temporal cortex of the 1st degree according to Scheltens was detected in 14 (30.4 %) patients in the main group, and atrophy of the parietal cortex of the 1st degree according to Koedam was observed in 8 (17.4 %). During ultrasound examination, signs of subclinical carotid artery lesions were found in 28 (69.9 %) patients with SVD and in 5 (16.7 %) individuals in the control group. When assessing the blood flow in the middle cerebral artery of all patients with SVD, an increase in the Gosling index to 1.15 ± 0.03 and Pourcelot index to 0.66 ± 0.03 was observed. The value of the pulsatility index correlated with the degree of damage according to Fazekas (r = 0.68) and age (r = 0.71), and to a lesser extent with the severity of atrophy of the temporal and parietal cortex (r = 0.35 and r = 0.33). In the control group, the average values of the pulsatility index were 0.79 ± 0.03 (p < 0.001), and the resistance index was 0.57 ± 0.03. When assessing the diagnostic value of the Dopplerometric method, it was established that its sensitivity is 0.96, and specificity is 0.85 (J = 0.81). Conclusions. Cerebral vascular Doppler ultrasound has a high diagnostic value for detecting diseases of small vessels and can be used to select candidates for neuroimaging verification of SVD.