BACKGROUND AND PURPOSE: Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol. METHODS: Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) criteria were used for identification of ≥50% stenosis. We determined velocity cutoffs for ≥70% stenosis on digital subtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria. RESULTS: A total of 102 patients with intracranial atherosclerotic disease (age 57±13 years; 72% men; median National Institutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtraction angiography, ≥50% stenosis was found in 97 and ≥70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (P>0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for ≥70% stenosis were: middle cerebral artery>120 cm/s (71%) and vertebral artery/basilar artery>110 cm/s (55%). Optimal combined criteria for ≥70% stenosis were: middle cerebral artery>120 cm/s, or stenotic/prestenotic ratio≥3, or low velocity (sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery>110 cm/s or stenotic/prestenotic ratio≥3 (60%, 95%, 0.769, respectively). CONCLUSIONS: At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of ≥50% stenosis. Novel velocity/ratio criteria for ≥70% stenosis increased sensitivity and showed good agreement with invasive angiography.
BACKGROUND AND PURPOSE:Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol. METHODS:Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) criteria were used for identification of ≥50% stenosis. We determined velocity cutoffs for ≥70% stenosis on digital subtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria. RESULTS: A total of 102 patients with intracranial atherosclerotic disease (age 57±13 years; 72% men; median National Institutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtraction angiography, ≥50% stenosis was found in 97 and ≥70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (P>0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for ≥70% stenosis were: middle cerebral artery>120 cm/s (71%) and vertebral artery/basilar artery>110 cm/s (55%). Optimal combined criteria for ≥70% stenosis were: middle cerebral artery>120 cm/s, or stenotic/prestenotic ratio≥3, or low velocity (sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery>110 cm/s or stenotic/prestenotic ratio≥3 (60%, 95%, 0.769, respectively). CONCLUSIONS: At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of ≥50% stenosis. Novel velocity/ratio criteria for ≥70% stenosis increased sensitivity and showed good agreement with invasive angiography.
Authors: G P Anzola; R Brighenti; M Cobelli; A Giossi; S Mazzucco; S Olivato; E Pari; M P Piras; A Padovani; F Rinaldi; G Turri Journal: Ultrasound Date: 2017-01-29
Authors: Pietro Caliandro; Giuseppe Reale; Andrew M Demchuk; Valeria Caso; Anita Arsovska; Chiara Iacovelli; Silvia Giovannini; Paolo Maria Rossini Journal: Neurol Sci Date: 2018-07-09 Impact factor: 3.307
Authors: Kristian Barlinn; Stanislava Kolieskova; Reza Bavarsad Shahripour; Jessica Kepplinger; Amelia K Boehme; Timo Siepmann; Volker Puetz; Ulf Bodechtel; William D Jordan; Andrei V Alexandrov Journal: J Stroke Cerebrovasc Dis Date: 2014-11-06 Impact factor: 2.136