Transcranial ultrasonography in the detection of cerebrovascular accident: a systematic review and bivariate random-effects meta-analysis

Background/objectives Stroke remains a leading cause of disability and death worldwide, with rapid diagnosis critical for effective treatment. Transcranial ultrasonography offers a potentially valuable diagnostic tool, particularly in resource-limited settings. This study aimed to evaluate the diagnostic accuracy of transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) for detecting ischemic and hemorrhagic stroke. Methods We conducted a systematic review and bivariate random-effects meta-analysis following PRISMA guidelines (PROSPERO CRD42023471425). Three databases (Scopus, PubMed, Web of Science) were searched from inception to November 20, 2022. We included studies assessing adult (≥18 years) stroke patients using TCD or TCCS compared to reference standards (MRI, CT, or angiography). Exclusion criteria included pediatric populations, animal studies, vasospasm assessments, and studies with