Clinical Neurology · Neurosonology

Reporting Templates

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Structured reporting reference for extracranial and transcranial studies (Wake Forest 2020 criteria).

Reporting Templates (Wake Forest Criteria 2020)

Extracranial Carotid System — Plaque & Stenosis Reference

Plaque Category	Measurement
Normal	< 1.1 mm
Minimal / Mild	1.1–2.0 mm
Moderate	2.1–4.0 mm
Large / Severe	> 4.0 mm

% Stenosis	PSV	EDV	ICA:CCA
< 50%	< 140 cm/s	< 40 cm/s	< 2.0
50–69%	> 140 cm/s	< 100 cm/s	2.0–3.0
70–99%	> 140 cm/s	> 100 cm/s	> 3.0
Stent
50–69%	175–299	—	—
≥ 70%	≥ 300	≥ 140	≥ 3.8

ECA: If ICA < 70%, an ECA PSV ≥ 140 cm/s suggests 50% or greater stenosis in the ECA. If ICA ≥ 70%, the cut point is increased to 200 cm/s.

CCA volume flow: Normally 300 cc/min ± 100; lower with advanced age. A side difference of 50% also suggests stenosis / collateral flow.

The extracranial carotid report documents, for each side: CCA volume flow (ml/min), CCA plaque (mild/mod/large), ICA velocity (cm/s), ICA % stenosis, ICA plaque, ECA velocity, ECA stenosis (< 50% / > 50%), bifurcation (BIF) velocity, BIF % stenosis, BIF plaque, and vertebral artery (VA) forward flow (yes/no).

Transcranial Findings Report

For each side, document depth, mean velocity, and pulsatility index for the MCA, ACA, terminal ICA, OA, IC siphon, PCA, and VA, plus the basilar artery. Normal mean velocity ranges: MCA 40–80, PCA 30–55, VA 25–50, ACA 35–60, ICA 40–70, BA 25–60.

TCD Vasospasm	Mean MCA	MCA/ICA
Normal	< 80	< 3
Mild	80–120	< 3
Moderate	120–200	3–6
Severe	> 200	> 6

Waveform interpretation: Pulsatility Index (PSV − EDV / MFV) normal range 0.6–1.2.
Normal: sharp upstroke, stepwise deceleration, robust diastole; < 30% side-to-side difference; normal velocity hierarchy MCA > ACA > siphon > PCA > BA.
High resistance: sharp upstroke, low EDV or no EDV, normal to decreased velocity, high PI.
Post-stenotic: decreased upslope, low peak velocity (tardus parvus), decreased PI.
Minimal: systolic spikes, absent EDV, decreased velocity.
CO2 reactivity: expect 30–50% increased MCA MFV; 20–30% mild reduction, 10–20% moderate, < 10% severe.

Interpretation pearls: Identify systole–diastole. Systole — sharpness of flow acceleration. End diastole consistent with expected resistance? Waveform shape transition from proximal to distal. Symmetry with the contralateral segment. Account for systemic factors (fever, anemia, hypotension, etc.). Explain the waveform appearance: technical factor, systemic condition, focal lesion, or resistance.

Ahmed Koriesh, MD

Sample TCD Reports — Format Critique

Annotated real-world transcranial Doppler reports from several laboratories, highlighting what each format does well and where it falls short — TAMMV labeling, ICA / basilar coverage, and the STOP-trial vessels. Click any report to enlarge.