Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2024-03-30 DOI:10.1111/jon.13197

Robert W. Regenhardt, Neal M. Nolan, Alvin S. Das, Rahul Mahajan, Andrew D. Monk, Sarah L. LaRose, Ibrahim Migdady, Yimin Chen, Faheem Sheriff, Xuesong Bai, Adam A. Dmytriw, Aman B. Patel, Samuel B. Snider, Henrikas Vaitkevicius

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Abstract

Background and Purpose

Thresholds for abnormal transcranial Doppler cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with cerebrovascular disease. Using a real-world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR).

Methods

CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation. The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2 SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp).

Results

A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean±SD age 55±16 years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean±SD CO2R for the unaffected side was 1.86±0.53%, defining abnormal CO2R as <0.80%. Mean±SD CO2R for the affected side was 1.27±0.90%. The CO2R threshold predicted abnormal acetazolamide single-photon emission computed tomography (SPECT) (Sn = .73, Sp = .79), CT/MRI perfusion abnormality (Sn = .42, Sp = .77), infarction on MRI (Sn = .45, Sp = .76), and pressure-dependent exam (Sn = .50, Sp = .76). For the unaffected side, mean±SD VMR was 39.5±15.8%, defining abnormal VMR as <7.9%. For the affected side, mean±SD VMR was 26.5±17.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn = .46, Sp = .94), infarction on MRI (Sn = .27, Sp = .94), and pressure-dependent exam (Sn = .31, Sp = .90).

Conclusions

In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is <0.80% and VMR is <7.9%. Noninvasive CVR may aid in diagnosing and risk stratifying patients with stenosis.

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经颅多普勒脑血管反应性：脑血管疾病临床意义的阈值。

背景和目的：人们对经颅多普勒脑血管反应性（CVR）研究异常的阈值知之甚少，尤其是对脑血管疾病患者而言。我们利用现实世界中患有脑动脉狭窄的人群，试图描述具有临床意义的二氧化碳反应性（CO2R）和血管运动范围（VMR）阈值：在正常呼吸室内空气、呼吸 8% 二氧化碳空气混合物和过度换气的条件下进行了 CVR 研究。计算单侧血管狭窄患者未受影响一侧的 CO2R 和 VMR 的平均值和标准差（SD）；选择低于平均值 2 SD 的偏差作为异常阈值。对单侧和双侧血管狭窄患者两侧的接收者操作特征（ROC）曲线进行敏感性（Sn）和特异性（Sp）评估：共对 62 名血管狭窄患者进行了 133 次连续 CVR 检查，患者平均（±SD）年龄为 55±16 岁。合并症包括高血压（60%）、糖尿病（15%）、中风（40%）和吸烟（35%）。在单侧血管狭窄患者中，未受影响一侧的 CO2R 平均值（±SD）为 1.86±0.53%，将 CO2R 异常定义为结论：在有多种血管风险因素的患者中，具有临床意义的 CO2R 异常的合理阈值是

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!