PT  - JOURNAL ARTICLE
AU  - Valaikiene, J.
AU  - Schuierer, G.
AU  - Ziemus, B.
AU  - Dietrich, J.
AU  - Bogdahn, U.
AU  - Schlachetzki, F.
TI  - Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis
AID  - 10.3174/ajnr.A0789
DP  - 2008 Feb 01
TA  - American Journal of Neuroradiology
PG  - 347--353
VI  - 29
IP  - 2
4099  - http://www.ajnr.org/content/29/2/347.short
4100  - http://www.ajnr.org/content/29/2/347.full
SO  - Am. J. Neuroradiol.2008 Feb 01; 29
AB  - BACKGROUND AND PURPOSE: Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the “gold standard,” digital subtraction angiography (DSA).Materials and METHODS: Forty patients (mean age, 58.9 ± 13.8 years) with intracranial ICA lesions were prospectively examined by using TCCS and DSA. Two standard TCCS coronal imaging planes were used to evaluate the intracranial ICA. In addition, a control group of 128 volunteers without cerebrovascular disease (mean age, 48.8 ± 15.9 years) was investigated to establish standard velocity values.RESULTS: DSA confirmed 96 stenoses and 8 occlusions of the intracranial ICA in the study population. In 9% and 7% of cases, stenosis confined to the C1 or C5 segment was >50% and 70%, respectively. Receiver-operating curves demonstrated cutoff values for >70% stenosis in C1 when the peak systolic velocity (PSV) was >200 cm/s (specificity, 100%; sensitivity, 71%) or the C1/submandibular ICA index was >3 (specificity, 93%; sensitivity, 86%).CONCLUSIONS: TCCS is a reliable adjunctive method to detect and quantify significant stenosis of the intracranial ICA. The assessment of the C1/ICA index and peak systolic velocities maximizes the diagnostic accuracy of C1 stenosis to >70% when extracranial ICA stenosis coexists. Further studies need to be performed to compare the diagnostic accuracies of MR angiography and TCCS with that of DSA.