Article Figures & Data
Figures
- FIG 1.
ROC analysis to predict RCVS using objective reversibility measurements and RCVS-2 scores. Circles identify best coordinates (cutoffs) for each curve.
- FIG 2.
A, Contrast-enhanced MRA of a patient with atypical RCVS. The posterior cerebral artery branches appear unremarkable. B, Lateral angiogram with areas of segmental narrowing in the posterior circulation. C, Pre-verapamil infusion DSA shows the caliber of a P3 branch = 0.6 mm. D, Post-verapamil infusion DSA shows a 0.3-mm CD (0.9 – 0.6 mm, 50% PC) in the P3 branch at the same level. These subtle changes in distal branches were not diagnosed in subjective assessments.
- FIG 3.
A, Patient with RCVS in the right anterior cerebral artery territory. B, Patient with RCVS in the right posterior cerebral artery territory. Note the classic string of beads pattern of the affected branches. The square delineates zoomed-in areas of the angiogram that were blindly analyzed by 2 readers. These measurements were later labeled as pre- and post-IA verapamil.
Tables
Variable RCVS (n = 9) No RCVS (n = 17) Pa Age (mean) (yr) 44.9 55.7 .06 Women (%) 8 (88.9) 10 (58.8) .19 Race White (%) 8 (88.9) 12 (70.6) .39 African American (%) 1 (11.1) 2 (11.8) Other (%) 0 (0) 3 (17.7) Medical history Migraine (%) 4 (44.4) 0 (0) .008 Depression/anxiety (%) 8 (88.9) 3 (17.6) .001 Hypertension (%) 2 (22.2) 14 (82.4) .009 Trigger/associated condition 7 (77.8) 2 (11.8) .002 Vasoconstrictive drugs SSRI (%) 6 (66.7) 1 (5.9) .002 Illicit drugs (%) 0 (0) 1 (5.9) .65 Postpartum (%) 2 (22.2) 0 (0) .11 Clinical presentation Thunderclap headache (%) 5 (55.6) 1 (5.9) .01 Other headaches (%) 2 (22.2) 5 (29.4) .54 Focal neurologic signs Hemiparesis/aphasia (%) 5 (55.6) 10 (58.8) .99 Visual symptoms (%) 3 (33.3) 1 (5.9) .10 Seizures (%) 2 (22.0) 1 (5.9) .27 Diagnostic work-up ESR (mean) (mm/h) 22.5 43.9 .31 CRP (mean) (mg/L) 3.0 1.9 .61 Normal CSFb (%) 2/5 (40.0) 4/9 (44.4) .99 Brain biopsy (%) 1 (11.1) 1 (5.9) .58 Abnormal neuroimaging findings (%) Infarct (%) 3 (33.3) 13 (76.5) .046 Multiple (%) 2/3 (66.7) 12/13 (92.3) .35 Borderzone territory (%) 2/3 (66.7) 1/13 (7.7) .08 IPH (%) 0 (0) 4 (23.5) .26 SAH in convexity (%) 5 (55.6) 2 (11.8) .03 CTA/MRA with vasculopathy CTA [n = 14]c (%) 2/5 (40) 5/9 (55.6) .99 MRA [n = 16]c (%) 2/6 (33.3) 10/10 (100) .008 Patients with intracranial vasculopathy on DSA not detected by CTA and/or MRA (n = 26) (%) 6/9 (66.7) 3/17 (17.6) .028 RCVS-2 score of ≥ 5 5 (55.6) 1 (5.9) .01 Note:—CRP indicates C-reactive protein; ESR, erythrocyte sedimentation rate; IPH, intraparenchymal hemorrhage; SSRI, selective serotonin reuptake inhibitor.
↵a P value calculated using a t test, χ2 test, or Fisher test as appropriate.
↵b Normal CSF if <5 cells and <50 mg/dL.
↵c Number of examinations performed including both groups.
- Table 3:
Cutoffs, AUC, sensitivity, specificity, and positive and negative predictive values of different reversibility measurements
Reversibility Measurement Cutoff AUC 95% CI Sen Spe PPV NPV Maximal PC (%) ≥32 0.951 0.87–1.00 100 88.2 81.8 100 Mean PC (%) ≥14.4 0.886 0.76–1.00 88.9 88.2 80 93.8 Maximal CD (mm) ≥0.45 0.840 0.68–0.99 77.8 82.4 70 87.5 Mean CD (mm) ≥0.125 0.882 0.75–1.00 88.9 76.5 66.7 92.8 RCVS-2 score (points) ≥5.0 0.908 0.79–1.00 77.8 94.1 87.5 88.9 Note:—NPV indicates negative predictive value; PPV, positive predictive value; Sen, sensitivity; Spe, specificity.
