Transcranial Doppler Velocities and Angiographic Vasospasm after SAH: A Diagnostic Accuracy Study.
Journal
AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
29
06
2021
accepted:
14
09
2021
pubmed:
20
11
2021
medline:
11
3
2022
entrez:
19
11
2021
Statut:
ppublish
Résumé
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. 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. 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 ( In this study, a threshold transcranial Doppler mean flow-velocity value that would accurately diagnose ≥50% angiographic vasospasm remained elusive.
Sections du résumé
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 (
CONCLUSIONS
In this study, a threshold transcranial Doppler mean flow-velocity value that would accurately diagnose ≥50% angiographic vasospasm remained elusive.
Identifiants
pubmed: 34794947
pii: ajnr.A7347
doi: 10.3174/ajnr.A7347
pmc: PMC8757545
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
80-86Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022 by American Journal of Neuroradiology.
Références
Acta Radiol Suppl. 1986;369:96-8
pubmed: 2980623
Stroke. 2001 Oct;32(10):2292-8
pubmed: 11588316
Neurosurgery. 1999 Jun;44(6):1237-47; discussion 1247-8
pubmed: 10371622
Stroke. 2009 Jun;40(6):1963-8
pubmed: 19359629
J Clin Neurosci. 1994 Jan;1(1):19-26
pubmed: 18638721
Acta Neurochir Suppl (Wien). 1988;42:81-4
pubmed: 3055838
Neurocrit Care. 2011 Sep;15(2):211-40
pubmed: 21773873
N Engl J Med. 2021 Mar 11;384(10):895-904
pubmed: 33704936
AJNR Am J Neuroradiol. 2021 Mar;42(3):501-507
pubmed: 33509923
J Neuroimaging. 2013 Oct;23(4):489-94
pubmed: 23163812
J Neurosurg. 1982 Dec;57(6):769-74
pubmed: 7143059
BMJ. 2015 Oct 28;351:h5527
pubmed: 26511519
Neurosurgery. 1999 Sep;45(3):443-9; discussion 449-50
pubmed: 10493365
J Neurosurg. 1998 Feb;88(2):272-6
pubmed: 9452235
AJNR Am J Neuroradiol. 2020 Apr;41(4):612-618
pubmed: 32217551
J Neuroimaging. 2011 Apr;21(2):177-83
pubmed: 20331498
J Neurosurg. 1978 Feb;48(2):173-8
pubmed: 624965
J Clin Ultrasound. 2012 Nov-Dec;40(9):535-9
pubmed: 22457239
Neurosurgery. 1999 May;44(5):975-9; discussion 979-80
pubmed: 10232530
J Neurosurg. 2007 Dec;107(6):1101-12
pubmed: 18077946
J Neurosurg. 2020 Oct 30;134(3):1006-1011
pubmed: 33126209
Radiology. 2005 Aug;236(2):621-9
pubmed: 16040918
Health Technol Assess. 2007 Dec;11(50):iii, ix-51
pubmed: 18021577
Crit Care Med. 2018 Oct;46(10):1665-1672
pubmed: 30080684
Stroke. 1995 Sep;26(9):1553-7
pubmed: 7660397