T E Darsaut1, M B Keough1, A M Chan1, B Farzin2, J M Findlay1, M M Chow1, M Chagnon3, J Zehr3, G Gevry2, J Raymond4. 1. From the Division of Neurosurgery (T.E.D., M.B.K., A.M.C., J.M.F., M.M.C.), Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada. 2. Department of Radiology (B.F., G.G., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 3. Department of Mathematics and Statistics (M.C., J.Z.), Pavillon André-Aisenstadt, Montreal, Quebec, Canada. 4. Department of Radiology (B.F., G.G., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada jean.raymond@Umontreal.ca.
Abstract
BACKGROUND AND PURPOSE: After aneurysmal SAH, transcranial Doppler is commonly used to monitor cerebral vasospasm. The diagnostic accuracy of transcranial Doppler flow velocity values in detecting angiographic vasospasm in patients requiring urgent endovascular intervention has not been established. MATERIALS AND METHODS: We performed a retrospective analysis of a consecutive series of patients with aneurysmal SAH who underwent transcranial Doppler (index test) within 24 hours of conventional angiography (reference test). The judgment of 33%, 50%, and 66% degree of vessel narrowing on angiography was independently established by multiple neuroendovascular clinicians. Vessel-specific per-segment and per-patient transcranial Doppler velocities were studied using receiver operating characteristic curves, the Youden index, and minimal acceptable sensitivity models. Optimal mean flow-velocity thresholds were explored to calculate sensitivity and specificity using a per-patient judgment of vasospasm of at least 50% angiographic narrowing in any large arterial segment except A1. RESULTS: In 221 patients, vasospasm was found in 15%, 8%, and 4% of arteries when the degree of reference angiographic luminal narrowing was 33%, 50%, and 66%, respectively. Mean flow velocities were significantly higher in vasospastic segments (P = . 001), but per-segment exploratory analyses yielded unsound mean flow velocity thresholds. The Youden and minimal acceptable sensitivity models proposed mean flow velocity thresholds of approximately 160 cm/s for the anterior circulation and 80 cm/s for the posterior circulation in the per-patient diagnosis of angiographic vasospasm (≥50%), yielding a sensitivity of 80%-90% (95% CI, 0.77-0.96), but with a corresponding specificity of 50% (95% CI, 0.40-0.56). CONCLUSIONS: In this study, a threshold transcranial Doppler mean flow-velocity value that would accurately diagnose ≥50% angiographic vasospasm remained elusive.
BACKGROUND AND PURPOSE: After aneurysmal SAH, transcranial Doppler is commonly used to monitor cerebral vasospasm. The diagnostic accuracy of transcranial Doppler flow velocity values in detecting angiographic vasospasm in patients requiring urgent endovascular intervention has not been established. MATERIALS AND METHODS: We performed a retrospective analysis of a consecutive series of patients with aneurysmal SAH who underwent transcranial Doppler (index test) within 24 hours of conventional angiography (reference test). The judgment of 33%, 50%, and 66% degree of vessel narrowing on angiography was independently established by multiple neuroendovascular clinicians. Vessel-specific per-segment and per-patient transcranial Doppler velocities were studied using receiver operating characteristic curves, the Youden index, and minimal acceptable sensitivity models. Optimal mean flow-velocity thresholds were explored to calculate sensitivity and specificity using a per-patient judgment of vasospasm of at least 50% angiographic narrowing in any large arterial segment except A1. RESULTS: In 221 patients, vasospasm was found in 15%, 8%, and 4% of arteries when the degree of reference angiographic luminal narrowing was 33%, 50%, and 66%, respectively. Mean flow velocities were significantly higher in vasospastic segments (P = . 001), but per-segment exploratory analyses yielded unsound mean flow velocity thresholds. The Youden and minimal acceptable sensitivity models proposed mean flow velocity thresholds of approximately 160 cm/s for the anterior circulation and 80 cm/s for the posterior circulation in the per-patient diagnosis of angiographic vasospasm (≥50%), yielding a sensitivity of 80%-90% (95% CI, 0.77-0.96), but with a corresponding specificity of 50% (95% CI, 0.40-0.56). CONCLUSIONS: In this study, a threshold transcranial Doppler mean flow-velocity value that would accurately diagnose ≥50% angiographic vasospasm remained elusive.
Authors: Joseph Sebastian; Carol Derksen; Khurshid Khan; Mohammad Ibrahim; Bilal Hameed; Muzaffar Siddiqui; Michael Chow; J Max Findlay; Ashfaq Shuaib; Maher Saqqur Journal: J Neuroimaging Date: 2012-11-19 Impact factor: 2.486
Authors: Michael N Diringer; Thomas P Bleck; J Claude Hemphill; David Menon; Lori Shutter; Paul Vespa; Nicolas Bruder; E Sander Connolly; Giuseppe Citerio; Daryl Gress; Daniel Hänggi; Brian L Hoh; Giuseppe Lanzino; Peter Le Roux; Alejandro Rabinstein; Erich Schmutzhard; Nino Stocchetti; Jose I Suarez; Miriam Treggiari; Ming-Yuan Tseng; Mervyn D I Vergouwen; Stefan Wolf; Gregory Zipfel Journal: Neurocrit Care Date: 2011-09 Impact factor: 3.210
Authors: Jennifer A Frontera; Andres Fernandez; J Michael Schmidt; Jan Claassen; Katja E Wartenberg; Neeraj Badjatia; E Sander Connolly; Stephan A Mayer Journal: Stroke Date: 2009-04-09 Impact factor: 7.914
Authors: T E Darsaut; C Derksen; B Farzin; M B Keough; R Fahed; W Boisseau; L Letourneau-Guillon; A-C Januel; A Weill; D Roy; T N Nguyen; S Finitsis; J-C Gentric; D Volders; A Carlson; M M Chow; C O'Kelly; J L Rempel; R A Ashforth; M Chagnon; J Zehr; J M Findlay; G Gevry; J Raymond Journal: AJNR Am J Neuroradiol Date: 2021-01-28 Impact factor: 3.825
Authors: Teresa A Hillier; Kathryn L Pedula; Keith K Ogasawara; Kimberly K Vesco; Caryn E S Oshiro; Suzanne L Lubarsky; Jan Van Marter Journal: N Engl J Med Date: 2021-03-11 Impact factor: 176.079
Authors: J Raymond; L Létourneau-Guillon; T E Darsaut; J M Findlay; M M Chow; M B Keough; A M Chan; Bezhad Farzin; G Gevry; M Chagnon; J Zehr Journal: AJNR Am J Neuroradiol Date: 2022-03-03 Impact factor: 3.825