Brachial artery Doppler assessment for detecting endothelial dysfunction

Last revised by Henry Knipe on 14 Jul 2023

Brachial artery Doppler assessment for detecting endothelial dysfunction is performed for detecting and classifying endothelial dysfunction by measuring the vascular dilation of the brachial artery, which is highly related to coronary endothelial dysfunction 1,4.

This test is generally indicated for assessing cardiovascular risk factors (diabetes, hypertension, dyslipidemia, smoking, obesity), coronary artery disease evaluation, and response to pharmacological treatment for endothelial dysfunction 1.

Radiographic features


The brachial artery is identified 2 cm above the elbow in a longitudinal plane. A baseline diameter during diastole. The diameter is measured again 60 seconds after a sphygmomanometer cuff is inflated to 200 mmHg around the forearm for 4.5 minutes and then released to evaluate flow-mediated vasodilation (FMD) 2.

The patient will then lie down again for at least 10 minutes. Subsequently, nitroglycerin-induced vasodilation (NID) is performed 3 with a dose of 200 mcg sublingual glyceride trinitrate, assessing brachial artery diameter at the same location after 10 minutes of the administration 2

Radiology report

There are no established criteria to evaluate degree of endothelial functionality, but some studies have shown that a dilation <7% in flow‐mediated vasodilation and 15% for nitroglycerin‐induced vasodilation 3 could indicate endothelial dysfunction in any of these tests.

In a normal endothelial function, brachial artery should dilate above 7% (FMD) and 15% (NID) respectively ref.

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