Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study.

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Abstract

There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography.

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Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

Hai-Chao Han, H.-C. Han (2012)

Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. However, the mechanisms of their formation and development are poorly understood. This review summarizes the current clinical and biomechanical studies on the initiation, development and treatment of tortuous blood vessels. We submit a new hypothesis that mechanical instability and remodeling could be mechanisms for the initiation and development of these tortuous vessels.

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Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography.

Chelsea S. Kidwell, Gary Duckwiler, James Sayre … (2005)

Although digital subtraction angiography (DSA) provides excellent visualization of the intracranial vasculature, it has several limitations. Our purpose was to evaluate the ability of helical CT angiography (CTA) to help detect and quantify intracranial stenosis and occlusion compared with DSA and MR angiography (MRA). Twenty-eight patients underwent CTA, DSA, and 3D time-of-flight (TOF) MRA for suspected cerebrovascular lesions. All three studies were performed within a 30-day period. Two readers blinded to prior estimated or calculated stenoses, patient history and clinical information examined 672 vessel segments. Lesions were categorized as normal (0-9%), mild (10-29%), moderate (30-69%), severe (70-99%), or occluded (no flow detected). DSA was the reference standard. Unblinded consensus readings were obtained for all discrepancies. A total of 115 diseased vessel segments were identified. After consensus interpretation, CTA revealed higher sensitivity than that of MRA for intracranial stenosis (98% versus 70%, P < .001) and occlusion (100% versus 87%, P = .02). CTA had a higher positive predictive value than that of MRA for both stenosis (93% versus 65%, P < .001) and occlusion (100% versus 59%, P < .001). CTA had a high interoperator reliability. In 6 of 28 patients (21%), all 6 with low-flow states in the posterior circulation, CTA was superior to DSA in detection of vessel patency. CTA has a higher sensitivity and positive predictive value than MRA and is recommended over TOF MRA for detection of intracranial stenosis and occlusion. CTA has a high interoperator reliability. CTA is superior to DSA in the evaluation of posterior circulation steno-occlusive disease when slow flow is present. CTA results had a significant effect on patient clinical management.

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How accurate is CT angiography in evaluating intracranial atherosclerotic disease?

Max Wintermark, Carol Lam, Eric Vittinghoff … (2008)

Digital subtraction angiography (DSA) is regarded as the gold standard in assessing degree of stenosis in intracranial vessels. However, it is invasive and can only be carried out at specialized centers. We sought to compare CT angiography (CTA) to DSA for detection and measurement of stenosis in large intracranial arteries. We identified all subjects admitted with ischemic stroke or transient ischemic attack and with CTA and DSA studies of good quality completed within 30 days of each other between April 2000 and May 2006 at a single medical center. Two readers blinded to clinical information reviewed each CTA and DSA independently. Each reader located and measured stenosis of 15 prespecified large intracranial arterial segments per study at the same level of magnification. These stenotic lesions were most likely atherosclerotic in etiology. All measurements were made with Wiha digiMax 6" digital calipers. The degree of stenosis was calculated using the published method for the Warfarin-Aspirin Symptomatic Intracranial Disease study. All disagreements of greater than 10% were reviewed by a third reader who decided between the 2 prior measurements. Segments were excluded from analyses if they were judged to be congenitally hypoplastic or seen only through collaterals or cross-filling. Intraclass correlation, sensitivity, and specificity were calculated using DSA as the reference standard. Forty-one pairs of CTA and DSAs from 41 patients were reviewed. CTAs were completed within 28 days before 13 days after DSA, with a median of 1 day. A total of 475 pairs of major intracranial arterial segment were analyzed. Intraclass correlation between degree of stenosis based on CTA and DSA for all segments was 0.98 (P=0.001). CTA detected large arterial occlusion with 100% sensitivity and specificity. For detection of >or=50% stenosis, CTA had 97.1% sensitivity and 99.5% specificity. To detect all lesions >or=50% as determined by DSA, the cut off point on CTA appeared to be at >or=30%, with a false-positive rate of 2.4%. Compared to DSA, CTA has high sensitivity and specificity for detecting >or=50% stenosis of large intracranial arterial segments. CTA is minimally invasive and may be a useful screening tool for intracranial arterial disease and occlusion.

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Author and article information

Journal

Journal ID (iso-abbrev): BMC Neurol

Title: BMC neurology

Publisher: Springer Nature

ISSN (Electronic): 1471-2377

ISSN (Print): 1471-2377

Publication date (Electronic): May 11 2017

Volume: 17

Issue: 1

Affiliations

[1 ] Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.

[2 ] Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.

[3 ] Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.

[4 ] Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany. jliman@gwdg.de.

Article

Publisher Item ID: 10.1186/s12883-017-0872-8

DOI: 10.1186/s12883-017-0872-8

PMC ID: 5426050

PubMed ID: 28490351

SO-VID: 2369e2fc-67ec-4131-be88-c218abb61d65

History

Keywords: Basilar artery stenosis,Doppler sonography,Duplex sonography,In stent restenosis

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Keywords: Basilar artery stenosis, Doppler sonography, Duplex sonography, In stent restenosis

Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study.

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Most cited references 23

Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography.

How accurate is CT angiography in evaluating intracranial atherosclerotic disease?

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