Accuracy of Color-Doppler in the Quantification of Proximal Vertebral Artery Stenoses

Abstract

Background: Vertebrobasilar (VB) strokes appear to have the same causes as carotid strokes. Obstructive lesions of proximal vertebral arteries probably occur in about 30% of stroke patients. Purpose: Our aim was to assess the validity of color Doppler sonography compared to selective intra-arterial angiography in the quantification of proximal vertebral artery stenoses. Materials and Methods: A prospective blind study of 316 vertebral arteries was undertaken between 1996 and 1998. One hundred and fifty-eight patients with cerebrovascular disorders without cerebral hemorrhage were studied consecutively by frequency or amplitude color Doppler flow imaging and intra-arterial angiography. The lesions were quantified by morphological and hemodynamic criteria and classified into 6 groups: 0% 207 arteries; 1–29% 32 arteries; 30–49% 29 arteries; 50–69% 13 arteries; 70–99% 23 arteries; 100% 12 arteries. Results: Ten of the 12 occlusions were identified, the 2 false-negatives were due to 2 revascularized vessels. Moderate stenoses (<50%) were differentiated from tight stenoses (>50%) using hemodynamic criteria. The majority of false-negative stenoses (38) in the different groups were related to intrathoracic or very deep origin of the artery, anechogenic stenosis or a tortuous vessel. Stenoses greater than 70% were diagnosed in 71% of cases with a specificity of 99%. The ĸ value was 0.80. Conclusion: Duplex sonography should be proposed first in VB attacks or stroke to detect and quantify vertebral artery stenoses for surgery and angioplasty.

Duplex ultrasonography for the detection of vertebral artery stenosis

“…This resulted in lower sensitivity of DUS compared with earlier studies (de Bray et al, 2001;Hua et al, 2009). In addition, we found that our proportion of adequate visualization of the V1 segment was rather low.…”

“…For vertebrobasilar stenosis, however, its diagnostic value is less clear (Ackerstaff, Grosveld, Eikelboom, & Ludwig, 1988;de Bray et al, 2001;Hua et al, 2009;Khan et al, 2007Khan et al, , 2009. We investigated the feasibility of DUS as a screening tool for the detection of extracranial vertebral artery stenosis in patients with posterior circulation TIA or stroke and assessed its diagnostic characteristics in comparison with CTA.…”

Imaging the vertebral artery

“…Ostial stenosis can also be inferred from the duplex waveform of the VA. A tardus waveform or flow velocities in excess of 100 cm/s [102] are suggestive of a stenosis. A prospective blind study of 158 patients found colour Doppler to have a sensitivity and specificity of 71 and 99%, respectively, for the detection of VA stenoses of more than 70% [103].…”

Diffusion weighted imaging, apparent diffusion coefficient maps and stroke etiology

“…For diagnosis of stenosis > 50 % (cut-off according to TOAST [1]) we used sonography in most cases. For the extracranial internal carotid artery [5], the large intracranial cerebral arteries and the vertebrobasilar arteries [6], published criteria of stenosis were applied. 2.…”