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.

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 ischaemic 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 < .05). Seventy-four plaques were identified in 50 patients, with good agreement between the 3 imaging (k > 0.6). CDUS was limited in evaluating Vertebral Arteries 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 40 and 43 vulnerable plaques, respectively. Conclusions: Colour Doppler ultrasound 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.