From the Department of Neurology (J.M.S., J.A.R., R.P.S., S.D., S.O.-G., E.C.L., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa.
AJNR Am J Neuroradiol. 2020 Oct;41(10):1869-1875. doi: 10.3174/ajnr.A6772. Epub 2020 Sep 17.
There is mounting evidence supporting the benefit of intra-arterial administration of vasodilators in diagnosing reversible cerebral vasoconstriction syndrome. We prospectively quantified the degree of luminal diameter dilation after intra-arterial administration of verapamil and its accuracy in diagnosing reversible cerebral vasoconstriction syndrome.
Patients suspected of having intracranial arteriopathy on noninvasive imaging and referred for digital subtraction angiography were enrolled in a prospective registry. Intra-arterial verapamil was administered in vascular territories with segmental irregularities. The caliber difference (Caliber - Caliber) and the proportion of caliber change ([(Caliber - Caliber)/Caliber] × 100%) were used to determine the response to verapamil. The diagnosis of reversible cerebral vasoconstriction syndrome was made on the basis of clinical and imaging features at a follow-up appointment, independent of the reversibility of verapamil. Receiver operating characteristic curve analysis was performed to determine the best threshold.
Twenty-six patients were included, and 9 (34.6%) were diagnosed with reversible cerebral vasoconstriction syndrome. A total of 213 vascular segments were assessed on diagnostic angiography. Every patient with a final diagnosis of reversible cerebral vasoconstriction syndrome responded to intra-arterial verapamil. The maximal proportion of change (< .001), mean proportion of change (= .002), maximal caliber difference (= .004), and mean caliber difference (= .001) were statistically different between patients with reversible cerebral vasoconstriction syndrome and other vasculopathies. A maximal proportion of change ≥32% showed a sensitivity of 100% and a specificity of 88.2% to detect reversible cerebral vasoconstriction syndrome (area under the curve = 0.951). The Reversible Cerebral Vasoconstriction Syndrome-2 score of ≥5 points achieved a lower area under the curve (0.908), with a sensitivity of 77.8% and a specificity of 94.1%.
Objective measurement of the change in the arterial calibers after intra-arterial verapamil is accurate in distinguishing reversible cerebral vasoconstriction syndrome from other vasculopathies. A proportion of change ≥32% has the best diagnostic performance.
越来越多的证据支持在诊断可逆性脑动脉收缩综合征时采用经动脉内给予血管扩张剂。我们前瞻性地定量评估了经动脉内给予维拉帕米后管腔直径扩张的程度及其在诊断可逆性脑动脉收缩综合征中的准确性。
对非侵入性影像学检查怀疑颅内动脉病变并转来行数字减影血管造影的患者进行前瞻性登记。在存在节段性不规则的血管区域内给予经动脉内维拉帕米。采用管腔直径差（Caliber - Caliber）和管腔变化比例（[(Caliber - Caliber)/Caliber] × 100%）来确定对维拉帕米的反应。根据随访时的临床和影像学特征诊断可逆性脑动脉收缩综合征，而不考虑维拉帕米的逆转情况。采用受试者工作特征曲线分析来确定最佳阈值。
共纳入 26 例患者，其中 9 例（34.6%）诊断为可逆性脑动脉收缩综合征。在诊断性血管造影上共评估了 213 个血管节段。所有最终诊断为可逆性脑动脉收缩综合征的患者均对经动脉内维拉帕米有反应。最大变化比例（ < .001）、平均变化比例（= .002）、最大管腔直径差（= .004）和平均管腔直径差（= .001）在可逆性脑动脉收缩综合征患者与其他血管病变患者之间存在统计学差异。最大变化比例 ≥32%时，对检测可逆性脑动脉收缩综合征的敏感性为 100%，特异性为 88.2%（曲线下面积=0.951）。可逆性脑动脉收缩综合征-2 评分 ≥5 分的曲线下面积较低（0.908），敏感性为 77.8%，特异性为 94.1%。
经动脉内给予维拉帕米后动脉管腔直径变化的客观测量可准确地区分可逆性脑动脉收缩综合征与其他血管病变。变化比例 ≥32%具有最佳的诊断性能。
