Transcranial Doppler Correlation with Angiography in Detection of Basilar Artery Stenosis

Tae-Kyu Yang, Al-An Seo, In-Young Yeo, Hyung-Do Kim. Woo-Sang Jung, Jung-Mi Park, Ok-Jun Kim. Byung-Ok Choi* Department of Oriental Internal Medicine, Pundang CHA Oriental Hospital, College of Medicine, Pochon CHA University Department of Neurology, Pundang CHA Hospital, College of Medicine, Pochon CHA University*

Objectives : Transcranial doppler(TCD) is a convenient non-invasive screening tool for intracranial stenoses. Several studies regarding the diagnostic value of TCD for detection of middle cerebral artery(MCA) stenosis have been published, Moreover, there have been few studies for basilar artery(BA) stenosis. So we aimed to evaluate the diagnostic accuracy of TCD in detecting BA stenosis among ischemic stroke patients when mean flow velocity(MFV) criteria was applied to them. Methods : Fifty-eight ischemic stroke patients(40 men and 18 women, mean age of 61.5) who underwent both cerebral angiography and TCD were observed. TCD was performed a mean of 5 days after angiography and TCD interpretation was performed according to standard criteria. Results : When we used MFV cutoff of 60cm/s in BA as the criteria for stenosis, 4 of 9 stenoses of any degree were detected by TCD with 6 out of 49 false positives. For BA stenosis, TCD had a sensitivity of 44%, specificity of 88%, positive predictive value 40%, negative predictive value 90% in this study. Conclusions : TCD may be a less effective screening test for BA stenosis when MFV criteria is used alone. To help avoid false negative results, examination for internal carotid artery(ICA) abnormalities shoud be performed before TCD.

Key Words: Intracranial stenosis, transcranial doppler(TCD), basilar artery

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689 .2 .3 BA angiography TCD TCD (mean flow velocity, MVF) >60cm/s .4 . , , ( digital subtraction angiography( DSA), 160mm/Hg, 90mm/Hg computed tomographic angiography( CTA), magnetic resonance angiography( MRA) ) ( 2 angiography TCD 200mg/dl ) (middle cerebral artery, MCA) , , homocysteine . (vertebral artery, VA) (basilar artery, BA) . 230mg/L , 200mg/L BA TCD . 15 mol/L . TCD Mann-Whitney U test 0.05 .

2001 12 1 2002 7 31 58 20 MRA transfemoral cerebral 38 large angiography(TFCA) 58 artery disease 10 , small artery disease 39 , . cardiogenic 5 , 4 . TCD 40 , 18 . 61.52( 12.01) 27 89 . , 37 , 18 , TCD Companion (Nicolet Biomedical, 13 , 9 , USA) angiog- 3 .(Table 1) Angiography raphy . BA TCD 2 26 TCD 5.12( 5.65) . 58 (suboccipital window) angiography BA 9 , 80mm (depth) 49 TCD BA (false positive) 6 , (false negative) 5 MFV

690 Table 1. General Characteristics of Subjects Table 2. TCD Accuracy Compared with Angiography to Differentiate Normal Versus Stenosis No. Age, yr 61.52( 12.01) Angiography Stenosis Normal Gender, Male 40 TCD Hypertension 37 Stenosis 4 6 DM 18 Normal 5 43 Hyperlipidemia 9 Total 9 49 Hypercholesterolemia 13 Hyperhomocysteinemia 3

Table 3. MFV, PI And Depth Between Stenosis And Normal TCD findings TCD TCD Normal Stenosis MFV(cm/s) 31.27 60.33 PI* 0.8731 0.8422 Depth(mm) 78.71 79.56 *: P>0.05 by Mann-Whitney U test for normal vs. stenosis monitoring screening . BA TCD TCD 7 (sensitivity) 44%, (specificity) 88% , (positive predictive value) 40%, Brain CT, MRI, TCD (negative predictive value) 90% .(Table 2) Pulsatility index( PI) TCD 8 TCD

MFV 31.27cm/s, 60.33cm/s .(Table 3) . TCD MFV PI MFV

TCD PI angiography .5 MFV PI . .9-23 (temporal window) TCD .5 MRA 6 , TCD .9 MRA 50 .

691 TCD MRA Tettonborn 25 76%, . MCA 86% . MFV >80cm/s Felberg (false positive) 44% 10 50% MCA MFV >100cm/s Gao 11 MRA . vertebrobasilar system >50% MCA MFV >140cm/s internal carotid artery( . ICA) ICA MFV . 20 MCA MFV TCD angiography PI Pulsatility transmission index(PTI, angiography %), ACA/MCA velocity ratio, PCA/MCA velocity TCD ratio, ACA velocities ratio(ACAVR) .

. 3 2 TCD BA Vertebrobasilar system 1 TCD MCA PI 1.65 . Homocysteine TCD

. TCD BA . 19 TCD VA

.13 24 , BA MCA BA MFV 35.3 9.28cm/s angiography TCD MFV 60cm/s BA . . BA 60cm/s Rorick 15 BA TCD MFV 70cm/s angiography BA 8 2 , MFV 30 6 (hyperemia) . vertebrobasilar system Cher 21 vertebrobasilar . ischemia DSA TCD 87%, 80%, 93%, 67% BA

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