Evaluation the accuracy of diagnostic criteria of basilar artery stenosis by transcranial Doppler combined with transcranial color code sonography

doi:10.3877/cma.j.issn.1672-6448.2015.04.005

Abstract

Abstract:

Objective

To investigate the accuracy of hemodynamic parameters of diagnostic criteria for basilar artery stenosis by transcranial Doppler (TCD) combined with transcranial color code sonography (TCCS).

Methods

261 cases with basilar artery stenosis detected by TCD or TCCS and confirmed by DSA were included in this study. The velocity of peak systolic (PSV_BA), end diastolic (EDV_BA), mean velocity (MFV_BA), the depth (D) at the stenosis, the highest PSV of bilateral posterior cerebral arteries (PSV_PCA) and intracranial segment of vertebral artery (PSV_VA) were detected and recorded respectively. Depending on the findings of DSA, the receiver operating characteristic curve (ROC) was used to evaluated the sensitivity, specificity and accuracy for the PSV_BA, EDV_BA, MFV_BA, PS_VBA/PSV_VA and PSV_BA/PSV_PCA.

Results

The depth of proximal, middle and distal segment of basilar artery stenosis were detected at (90±5.4) mm, (97+3.0) mm, and (104+4.2) mm respectively. The best parameter of diagnostic criteria for the mild、middle and severe basilar artery stenosis were 110 cm/s≤PSV_BA≤150 cm/s or 65 cm/s≤MFV_BA≤90 cm/s, 150 cm/s≤PSV_BA≤210 cm/s or 90 cm/s≤MFV_BA≤135 cm/s and PSV_BA≥210 cm/s or PSV_BA/PSV_VA≥3.5.

Conclusion

The combination of TCD and TCCS, and choosing the hemodynamic parameters of PSV, MFV and PSV_BA/PSV_VA , can better assess the basilar artery stenosis, especially for severe basilar artery stenosis.

Key words: Ultrasonography, Doppler, transcranial, Vertebrobasilar insufficiency, Basilar artery

Jie Yang, Yang Hua, Lili Wang, Xinyu Zhao, Chen Ling, Beibei Liu. Evaluation the accuracy of diagnostic criteria of basilar artery stenosis by transcranial Doppler combined with transcranial color code sonography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(04): 271-277.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2015.04.005

https://chaosheng.cma-cmc.com.cn/EN/Y2015/V12/I04/271

Figures/Tables 7

References 20

[1]	De Marchis GM,Kohler A,Renz N et al. Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics[J]. J Neurol Neurosurg Psychiatry, 2011, 82(1): 33-37.
[2]	Schneider JI,Olshaker JS. Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke[J]. Emerg Med Clin North Am, 2012, 30(3): 681-693.
[3]	Flossmann E,Rothwell PM. Prognosis of vertebrobasilar transient ischaemic attack and minor stroke[J]. Brain, 2003, 126(9): 1940-1954.
[4]	Josephson SA,Dillon WP,Smith WS. Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging[J]. Neurology, 2005, 64(10): 1805-1806.
[5]	孟秀峰,华扬,刘蓓蓓, 等. 经颅多普勒超声诊断大脑中动脉狭窄准确性的研究. 中国脑血管病杂志, 2010, 7(6): 284-289.
[6]	The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Prognosis of patients with symptomatic vertebral or basilar artery stenosis. Stroke, 1998, 29(7): 1389-1392.
[7]	Woolfenden AR,Tong DC,Norbash AM, et al. Basilar artery stenosis: clinical and neuroradiographic features[J]. J Stroke Cerebrovasc Dis, 2000, 9(2): 57-63.
[8]	华扬. 实用颈动脉与颅脑血管超声诊断学[M]. 北京: 科学出版社, 2002: 17-44.
[9]	Aburahma A,Bergan J. Noninvasive Cerebrovascular Diagnosis. London: Springer-verlag London Limited, 2010, 73-96.
[10]	De Bray JM,Missoum A,Dubas F, et al. Detection of vertebrobasilar intracranial stenoses: transcranial Doppler sonography versus angiography[J]. J Ultrasound Med, 1997, 16(3): 213-218.
[11]	Baumgartner RW,Mattle HP,Schroth G, et al. Assessment of ≥50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke, 1999, 30(1): 87-92.
[12]	Felberg RA,Christou I,Demchuk AM, et al. Screening for intracranial stenosis with transcranial Doppler: the accuracy of mean flow velocity thresholds[J]. J Neuroimaging, 2002, 12(1): 9-14.
[13]	Ghorbani A,Ashtari F,Fatehi F. The assessment value of transcranial Doppler sonography versus magnetic resonance angiography in vertebrobasilar stroke[J]. J Res Med Sci, 2010, 15(3): 133-139.
[14]	Zhao L,Barlinn K,Sharma VK, et al. Velocity criteria for intracranial stenosis revisited: an international multicenter study of transcranial Doppler and digital subtraction angiography. Stroke. 2011, 42(12): 3429-3434.
[15]	Grant EG,Benson CB,Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology, 2003, 229(2): 340-346.
[16]	Chua HC,Sitoh YY,Earnest A, et al. Detection of internal carotid artery stenosis with duplex velocity criteria using receiver operating characteristic analysis. Ann Acad Med Singapore, 2007, 36(4): 247-252.
[17]	Alexandrov AV. The Spencer's Curve: clinical implications of a classic hemodynamic model. J Neuroimaging, 2007, 17(1): 6-10.
[18]	Sharma VK,Tsivgoulis G,Lao AY, et al. Noninvasive detection of diffuse intracranial disease. Stroke, 2001, 38(12): 3175-3181.
[19]	华扬,刘蓓蓓,凌晨, 等. 超声检查对颈动脉狭窄50%~69%和70%~99%诊断准确性的评估. 中国脑血管病杂志, 2006, 3(5): 211-218.
[20]	Hua Y,Meng XF,Jia LY, et al. Color Doppler imaging evaluation of proximal vertebral artery stenosis. AJR Am J Roentgenol, 2009, 193(5): 1434-1438.

基底动脉狭窄段位置	血管支数（支）	检测深度（mm）	平均深度（mm）
近段	83	78～98	90.0±5.4
中段	93	90～106	97.0±3.0
远段	39	96～114	104.0±4.2

基底动脉狭窄段位置	血管支数（支）	检测深度（mm）	平均深度（mm）
近段	83	78～98	90.0±5.4
中段	93	90～106	97.0±3.0
远段	39	96～114	104.0±4.2

分类	狭窄程度
	<49%			50%~69%			70%~99%
	AUC	95% CI	P值	AUC	95% CI	P值	AUC	95% CI	P值
PSV	0.975	0.936-0.977	<0.01	0.990	0.983-0.997	<0.01	0.975	0.962-0.989	<0.05
EDV	0.935	0.908-0.962	<0.05	0.972	0.957-0.987	<0.05	0.958	0.936-0.979	<0.05
MV	0.951	0.928-0.973	<0.05	0.987	0.978-0.995	<0.01	0.972	0.958-0.986	<0.01
PSV_BA/PSV_VA	0.960	0.937-0.982	<0.05	0.960	0.937-0.983	<0.05	0.960	0.934-0.987	<0.05
PSV_BA/PSV_PCA	0.958	0.936-0.981	<0.05	0.918	0.882-0.955	<0.05	0.927	0.886-0.968	<0.05

分类	狭窄程度
	<49%			50%~69%			70%~99%
	AUC	95% CI	P值	AUC	95% CI	P值	AUC	95% CI	P值
PSV	0.975	0.936-0.977	<0.01	0.990	0.983-0.997	<0.01	0.975	0.962-0.989	<0.05
EDV	0.935	0.908-0.962	<0.05	0.972	0.957-0.987	<0.05	0.958	0.936-0.979	<0.05
MV	0.951	0.928-0.973	<0.05	0.987	0.978-0.995	<0.01	0.972	0.958-0.986	<0.01
PSV_BA/PSV_VA	0.960	0.937-0.982	<0.05	0.960	0.937-0.983	<0.05	0.960	0.934-0.987	<0.05
PSV_BA/PSV_PCA	0.958	0.936-0.981	<0.05	0.918	0.882-0.955	<0.05	0.927	0.886-0.968	<0.05

血流动力学参数	流速（cm/s）	敏感度（%）	特异度（%）	准确性（%）	阳性预测值（%）	阴性预测值（%）
PSV_BA	≥105	94.9	87.0	93.5	97.1	78.4
	≥110	93.5	97.8	94.3	99.5	76.3
	≥115	91.6	100.0	92.7	100.0	71.8
EDV_BA	≥40	96.3	73.9	92.3	94.5	80.9
	≥45	92.6	93.5	92.7	98.5	72.9
	≥50	85.1	97.8	87.3	99.5	58.4
MFV_BA	≥60	96.3	80.4	93.4	95.8	82.2
	≥65	93.5	95.7	93.8	99.0	75.8
	≥70	90.7	100.0	92.3	100.0	69.7

Please choose a citation manager

Content to export