A New Transcranial Doppler Scoring System for Evaluating Middle Cerebral Artery Stenosis.
A New Transcranial Doppler Scoring System for Evaluating Middle Cerebral Artery Stenosis.
复制标题
用于评估大脑中动脉狭窄的新型经颅多普勒评分系统。
DOI：
10.1111/jon.12678
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Levine,StevenR
中科院分区：
文献类型：
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作者：
Hao,Qing;Feldmann,Edward;Balucani,Clotilde;Zubizarreta,Nicole;Zhong,Xiaobo;Levine,StevenR
经颅多普勒（TCD）诊断脑血管狭窄的标准仅基于血流速度，在以往的研究中阳性预测值（PPV）并不令人满意。我们改进了一个已发表的评分系统，该系统整合了TCD数据在诊断大脑中动脉（MCA）stenosis. METHODS中的几个特征，使用来自卒中结局和颅内动脉粥样硬化神经成像（SONIA）试验的TCD数字减影血管造影（DSA）数据库，对速度、频谱模式、弥散比和不对称比进行了评估。为每个参数定义临界点，并为该参数内的每个类别指定一个点值。计算每个MCA的总分。评估不同截断点预测DSA测量MCA狭窄≥50%的准确性。采用Logistic回归和C统计进行分析，基于血管的分析中纳入了114例MCA，基于患者的分析中纳入了87例患者。与SONIA中仅流速临界点相比，该评分导致PPV大幅改善，而阴性预测值（NPV）保持不变。基于平均速度的分数（评分0：<140 cm/s，评分3：≥140 cm/s），频谱模式（0分：无湍流; 1分：轻度湍流; 2分：显著湍流）和不对称率（评分0：比值<1.5，评分1：比值1.5 - 2;评分2：比值≥2.1）具有最高的NPV，而PPV保持有利（PPV：72% [95% CI：54 - 90%]; NPV：84% [95% CI：75 - 93%]，曲线下面积[AUC]：0.76 [95% CI：.66-.86]）。结论：在诊断MCA ≥50%时，与单参数速度标准相比，结合TCD测量的几个特征的多参数评分系统产生更高的PPV，同时保持高的NPV。狭窄。
BACKGROUND AND PURPOSETranscranial Doppler (TCD) criteria for cerebrovascular stenosis are only based on velocity with unsatisfactory positive predictive value (PPV) in previous studies. We refined a published scoring system that integrates several characteristics of TCD data in diagnosing middle cerebral artery (MCA) stenosis.METHODSUsing the TCD‐digital subtraction angiography (DSA) database from Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial, velocity, spectrum pattern, diffuse ratio, and asymmetry ratio were assessed. The cutpoints were defined for each parameter and a point value was assigned to each category within that parameter. A summed score was calculated for each MCA. The accuracy was assessed for different cutpoints in predicting ≥50% MCA stenosis measured by DSA. Logistic regression and C‐statistics were used for analysis.RESULTSA total of 114 MCAs were included in vessel‐based and 87 patients were included in patient‐based analysis. Compared to the velocity‐only cutpoints in SONIA, the score results in much improved PPV while negative predictive value (NPV) remains unchanged. The score based on mean velocity (score 0: <140 cm/s, score 3: ≥140 cm/s), spectrum pattern (score 0: no turbulence; score 1: mild turbulence; 2: significant turbulence), and asymmetry ratio (score 0: ratio <1.5, score 1: ratio 1.5‐2; score 2: ratio ≥2.1) has the highest NPV while PPV remains favorable (PPV: 72% [95% CI 54‐90%]; NPV: 84% [95% CI: 75‐93%], area under curve [AUC]: .76 [95% CI: .66‐.86]).CONCLUSIONSThe multiparameter scoring system incorporating several characteristics of TCD measures yielded higher PPV while maintaining high NPV compared with the single‐parameter velocity criteria in diagnosing MCA ≥50% stenosis.