Koh Woori, Kallenberg Kai, Karch André, Frank Tobias, Knauth Michael, Bähr Mathias, Liman Jan
Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
BMC Neurol. 2017 May 11;17(1):89. doi: 10.1186/s12883-017-0872-8.
There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography.
We analyzed data of 104 examinations of the basilar artery. The association between sonographic peak systolic velocity (PSV) and degree of stenosis obtained by cerebral angiography was evaluated applying Spearman's correlation coefficient. Receiver Operating Characteristics (ROC) curves and areas under the curve (AUC) were calculated for the detection of a ≥50% stenosis defined by angiography. Optimal cut-off was derived using the Youden-index.
A weak but statistically significant correlation between PSV and the degree of stenosis was found (n=104, rho=0.35, p<0.001). ROC analysis for a detection of ≥50% stenosis showed an AUC of 0.70, a sensitivity of 74.0% and a specificity of 65.0% at the optimal cut off of 124 cm/s. Results were consistent when analyzing examinations done in stented and unstented arteries separately (TCD VS DSA/CTA in unstented artery: AUC=0.66, sensitivity 61.0%, specificity 65.0%, TCD/TCCS VS DSA in stented artery: AUC=0.63, sensitivity 71.0%, specificity 82.0%). Comparing TCCS measurements exclusively to angiography, ROC analysis showed an AUC of 1.00 for the detection of an in-stent-restenosis ≥50% with a sensitivity and specificity of 100% when a PSV of 132 cm/s was used as a cut off value.
Validity of TCD in the assessment of basilar artery stenosis or in-stent restenosis is poor. First results for TCCS are promising, but due to the small samplesize further studies with larger samples sizes are warranted.
关于经颅超声检查（TCD和TCCS）对基底动脉检查的有效性存在相互矛盾的报道。在此，我们将经颅超声检查与脑血管造影术相比较，研究其对基底动脉狭窄和支架内再狭窄检测的敏感性和特异性。
我们分析了104例基底动脉检查的数据。应用Spearman相关系数评估超声收缩期峰值流速（PSV）与脑血管造影所获狭窄程度之间的关联。计算检测血管造影定义的≥50%狭窄的受试者工作特征（ROC）曲线及曲线下面积（AUC）。使用约登指数得出最佳截断值。
发现PSV与狭窄程度之间存在微弱但具有统计学意义的相关性（n = 104，rho = 0.35，p < 0.001）。检测≥50%狭窄的ROC分析显示，在最佳截断值为124 cm/s时，AUC为0.70，敏感性为74.0%，特异性为65.0%。分别分析支架置入和未置入动脉的检查结果时，结果一致（未置入动脉中TCD与DSA/CTA比较：AUC = 0.66，敏感性61.0%，特异性65.0%；支架置入动脉中TCD/TCCS与DSA比较：AUC = 0.63，敏感性71.0%，特异性82.0%）。仅将TCCS测量结果与血管造影术比较时，ROC分析显示，检测≥50%支架内再狭窄的AUC为1.00，当PSV为132 cm/s用作截断值时，敏感性和特异性均为100%。
TCD评估基底动脉狭窄或支架内再狭窄的有效性较差。TCCS的初步结果很有前景，但由于样本量小，需要进行更大样本量的进一步研究。
