Diagnostic accuracy of transcranial ultrasonography for detecting stenosis in patients with acute ischaemic stroke: a systematic review and meta-analysis

Aim: Transcranial ultrasonography, including transcranial doppler (TCD) and transcranial colour-coded duplex/sonography (TCCD/TCCS), offers potential benefits in the evaluation of cerebrovascular patency, but its accuracy remains under scrutiny. Hence, this study aims to investigate the diagnostic accuracy of transcranial ultrasonography for detecting stenosis in acute ischaemic stroke patients.Material and methods: We systematically reviewed the databases such as CINAHL, SCOPUS, EMBASE, MEDLINE, Cochrane Library, Google Scholar, and ScienceDirect from inception till June 2023. Studies were eligible if they compared the diagnostic role of transcranial ultrasonography with established techniques, and reported accuracy parameters such as sensitivity, specificity, positive and negative likelihood ratios. Subgroup analysis was performed for TCD and TCCD/TCCS.Results: Seventeen studies involving 1496 participants were included. The pooled sensitivity and specificity of transcranial ultrasonography were 90% and 95% respectively. For TCD, the sensitivity and specificity were 87% and 93% respectively. TCCD/TCCS showed sensitivity 98% and specificity 97%. High clinical value was evident in both TCD and TCCD/TCCS, with heterogeneity across studies but no observable publication bias.Conclusion: Transcranial ultrasonography, including both TCD and TCCD/TCCS, demonstrates high diagnostic accuracy in detecting stenosis in patients with acute ischaemic stroke. These findings support the utility of these methods as reliable, non-invasive tools for cerebrovascular assessment