Fisse Anna Lena, Pueschel Johannes, Deppe Michael, Ringelstein E Bernd, Ritter Martin A
Department of Neurology, University Hospital Muenster, Muenster, Germany.
Cerebrovasc Dis. 2016;41(1-2):50-9. doi: 10.1159/000441921. Epub 2015 Nov 25.
There is an unmet need for screening methods to detect and quantify cerebral small vessel disease (SVD). Transcranial Doppler ultrasound (TCD) flow spectra of the larger intracranial arteries probably contain relevant information about the microcirculation. However, it has not yet been possible to exploit this information as a valuable biomarker.
We developed a technique to generate normalized and averaged flow spectra during middle cerebral artery Doppler ultrasound examinations. Second, acceleration curves were calculated, and the absolute amount of the maximum positive and negative acceleration was calculated. Findings were termed 'TCD-profiling coefficient' (TPC). Validation study: we applied this noninvasive method to 5 young adults for reproducibility. Degenerative microangiopathy study: we also tested this new technique in 30 elderly subjects: 15 free of symptoms but with MRI-verified presence of cerebral SVD, and 15 healthy controls. SVD severity was graded according to a predefined score. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) study: TPC values of 10 CADASIL patients were compared with those of 10 healthy controls. Pulse wave analysis and local measurements of carotid stiffness were also performed. CADASIL patients were tested for cognitive impairment with the Montreal Cognitive Assessment scale. White matter and basal ganglia lesions in their cerebral MRI were evaluated according to the Wahlund score.
Validation study: the technique delivered reproducible results. Degenerative microangiopathy study: patients with SVD had significantly larger TPCs compared with controls (SVD: 2,132; IQR 1,960-2,343%/s vs.
1,935; IQR 1,782-2,050%/s, p = 0.01). TPC values of subjects with SVD significantly correlated with SVD severity scores (R = 0.58, n = 15, p < 0.05). CADASIL study: TPC values of CADASIL patients were significantly higher than values of the controls (CADASIL: 2,504; IQR 2,308-2,930%/s vs. controls 2,084; 1,839-2,241%/s, p = 0.008), and also significantly higher than the TPC values of the patients with SVD from the degenerative microangiopathy study (p = 0.007). CADASIL patients had significantly worse cognitive test results than healthy controls.
TCD-profiling detects impairment of the cerebral microcirculatory state. The suitability of the TCD-profiling for the evaluation of cerebral microangiopathy was confirmed.
对于检测和量化脑小血管疾病（SVD）的筛查方法仍存在未满足的需求。较大颅内动脉的经颅多普勒超声（TCD）血流频谱可能包含有关微循环的相关信息。然而，尚未能够将这些信息用作有价值的生物标志物。
我们开发了一种技术，用于在大脑中动脉多普勒超声检查期间生成标准化和平均血流频谱。其次，计算加速度曲线，并计算最大正加速度和负加速度的绝对值。结果被称为“TCD分析系数”（TPC）。验证研究：我们将这种非侵入性方法应用于5名年轻成年人以评估其可重复性。退行性微血管病研究：我们还在30名老年受试者中测试了这项新技术：15名无症状但MRI证实存在脑SVD，以及15名健康对照。根据预定义评分对SVD严重程度进行分级。伴有皮质下梗死和白质脑病的脑常染色体显性动脉病（CADASIL）研究：将10名CADASIL患者的TPC值与10名健康对照的TPC值进行比较。还进行了脉搏波分析和颈动脉僵硬度的局部测量。使用蒙特利尔认知评估量表对CADASIL患者进行认知障碍测试。根据瓦伦德评分评估其脑部MRI中的白质和基底节病变。
验证研究：该技术提供了可重复的结果。退行性微血管病研究：与对照组相比，SVD患者的TPC明显更大（SVD：2,132；四分位距1,960 - 2,343%/秒 vs. 对照组：1,935；四分位距1,782 - 2,050%/秒，p = 0.01）。SVD受试者的TPC值与SVD严重程度评分显著相关（R = 0.58，n = 15，p < 0.05）。CADASIL研究：CADASIL患者的TPC值显著高于对照组（CADASIL：2,504；四分位距为2,308 - 2,930%/秒 vs. 对照组2,084；1,839 - 作者：2,241%/秒，p = 0.0）。
TCD分析可检测脑微循环状态的损害。证实了TCD分析在评估脑微血管病方面的适用性。
