Imaging Correlation of Color Doppler Ultrasound, CT Angiography, and MR Angiography Findings in Extracranial Carotid and Vertebral Artery Disease Among Ischemic Stroke Patients: A Prospective Observational Study

Background and objectiveExtracranial carotid and vertebral artery (VA) atherosclerosis is an important contributor to ischemic stroke and recurrent cerebrovascular events.Color Doppler ultrasound is widely used as an accessible first-line modality, whereas CT angiography (CTA) and MR angiography (MRA) provide additional anatomical information regarding stenosis, plaque morphology, occlusion, and vascular variants.The objective of this study was to describe extracranial carotid and VA abnormalities in ischemic stroke patients using color Doppler ultrasound, CTA, and MRA and to assess aggregate distributional patterns of plaque characteristics and stenosis grades across these imaging modalities. MethodsThis prospective observational imaging correlation study included 50 patients with clinically suspected and neuroimaging-confirmed ischemic stroke who underwent extracranial vascular assessment.Demographic profile, vascular risk factors, Doppler plaque type, spectral broadening, CTA plaque morphology, MRA findings, and stenosis grades were analyzed.Additional descriptive and exploratory aggregate statistics included 95% CIs, chi-square tests for categorical distributions, aggregate modality-wise comparison of stenosis grades, and correlation of matched vessel-category stenosis percentages. ResultsThe mean age was 63.6 ± 13.34 years (95% CI, 59.8-67.4),and 30 patients (60.0%) were male.Hypertension and smoking were the most frequent risk factors, each present in 27 patients (54.0%, 95% CI, 40.4-67.0),followed by diabetes mellitus in six patients (12.0%).The highest age-group burden was observed in the 61-70-year category (18/50, 36.0%;χ² = 13.00,p = 0.011).Doppler identified 76 plaque-positive vessel observations across eight evaluated vessel segments, with type II plaque being most frequent (32/76, 42.1%; p < 0.001).CTA plaque assessment showed an irregular plaque surface in 40/74 plaque observations (54.1%) and fatty or mixed plaques in 30/74 observations each (40.5%).Across five vessel segments and 250 vessel observations per modality, clinically significant stenosis (≥50% stenosis or occlusion) was noted in 14 observations (5.6%) by Doppler, 14 (5.6%) by CTA, and 18 (7.2%)by MRA; the aggregate between-modality difference was not statistically significant (χ² = 0.74, p = 0.690).Matched vessel-category stenosis percentages showed very strong aggregate correlations between Doppler and CTA (Pearson r = 0.981), Doppler and MRA (r = 0.988), and CTA and MRA (r = 0.970; all p < 0.001). ConclusionsColor Doppler ultrasound demonstrated useful screening capability for extracranial carotid disease in ischemic stroke patients, while CTA and MRA added anatomical clarification of plaque morphology, stenosis, occlusion, and vertebrobasilar variants.The stenosis-grade distribution appeared comparable across modalities at an aggregate level; however, patient-level agreement, diagnostic accuracy measures, and outcome correlation could not be established without larger datasets containing paired raw imaging results and standardized reference criteria.