Lee Seung-Jae, Lee Tae-Kyeong, Moon Ji Eun
Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
J Neuroimaging. 2023 Sep-Oct;33(5):852-859. doi: 10.1111/jon.13131. Epub 2023 Jun 9.
The diagnostic value of vertebral artery foraminal segment (V2) ultrasonography remains unclear. This study aimed to estimate the predictive value of V2 Doppler imaging for the detection of vertebrobasilar stenosis or occlusion.
Three hundred sixty-four vertebral arteries from 182 patients were investigated. Abnormal Doppler spectra were categorized as high-resistance flow (resistive index ≥0.9), low-resistance flow (resistive index ≤0.5), increased flow velocity (peak systolic velocity ≥137.5 cm/second), or no flow signal. On MR angiography, stenosis and occlusion were defined as >50% narrowing and absent flow signals, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Sixty of 364 vertebral arteries (16.5%) had V2 Doppler abnormalities, while 89 vertebrobasilar arteries (24.5%) had a stenosis or occlusion. The Doppler abnormalities predicted any stenosis or occlusion in the vertebrobasilar artery with a sensitivity of 56.2% and specificity of 96.4% (PPV, 83.3%; NPV, 87.2%). The hypoplastic vertebral artery (lumen diameter ≤2.7 mm) was more frequently associated with vertebrobasilar stenosis or occlusion, and with abnormal Doppler spectra (mostly high-resistance flow), even when it was nonstenotic, than the normal-diameter vertebral artery (p < .001, chi-square test).
The low sensitivity seems to be due to the high prevalence of non-V2 lesions not detected on V2 Doppler imaging, suggesting the necessity for a more extensive sonographic examination beyond V2. However, PPV and NPV ≥80% may suggest its usefulness in clinical practice.
椎动脉椎间孔段（V2）超声检查的诊断价值仍不明确。本研究旨在评估V2多普勒成像对椎基底动脉狭窄或闭塞检测的预测价值。
对182例患者的364条椎动脉进行了研究。异常多普勒频谱分为高阻力血流（阻力指数≥0.9）、低阻力血流（阻力指数≤0.5）、血流速度增加（收缩期峰值速度≥137.5厘米/秒）或无血流信号。在磁共振血管造影上，狭窄和闭塞分别定义为狭窄>50%和无血流信号。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
364条椎动脉中有60条（16.5%）存在V2多普勒异常，而89条椎基底动脉（24.5%）存在狭窄或闭塞。多普勒异常对椎基底动脉任何狭窄或闭塞的预测敏感性为56.2%，特异性为96.4%（PPV，83.3%；NPV，87.2%）。发育不全的椎动脉（管腔直径≤2.7毫米）比正常直径的椎动脉更常与椎基底动脉狭窄或闭塞以及异常多普勒频谱（主要是高阻力血流）相关，即使它无狭窄（卡方检验，p<0.001）。
低敏感性似乎是由于V2多普勒成像未检测到的非V2病变患病率较高，这表明除V2外进行更广泛超声检查的必要性。然而，PPV和NPV≥80%可能表明其在临床实践中的有用性。
