Noninvasive imaging of the cervical vertebral artery in the diagnosis of vertebrobasilar insufficiency.

The cervical vertebral arteries were visualized by real-time B-mode ultrasonography with duplex Doppler in 595 consecutive patients. Comparison with angiography in 40 patients showed a sensitivity of 84% and a specificity of 97% in identifying vertebral artery lesions. The incidence of vertebral artery lesions in patients with symptoms of ischemia referable to the vertebrobasilar distribution was 28% (24/84), significantly higher (p = 0.05) than the incidence of 13% (7/54) in patients with carotid artery insufficiency. Patients with completed strokes in the vertebrobasilar territory had an even higher incidence of vertebral lesions (44%,14/ 32) than patients with transient symptoms of vertebrobasilar insufficiency (19%, 10/52) (p < 0.001). The incidence of vertebral lesions in patients with nonlocalizing symptoms of syncope (8%, 5/67), presyncope (10%, 3/31), isolated vertigo (5%,4/77), unsteadiness (4%,2/55), lightheadedness (0/27), and transient global amnesia (0/18) were all significantly lower than the incidence in patients with focal vertebrobasilar symptoms (p < 0.01). Imaging of the cervical vertebral arteries by real-time B-mode ultrasonography may be helpful in determining the etiology of symptoms in patients with a diagnosis of vertebrobasilar insufficiency.