The value of transcranial Doppler derived pulsatility index for diagnosing cerebral small-vessel disease

Ghorbani, Abbas; Ahmadi, Mohammad Javad; Shemshaki, Hamidreza

The value of transcranial Doppler derived pulsatility index for diagnosing cerebral small-vessel disease

Authors

Department of Neurology, Isfahan Neuroscience Research Center, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The pulsatility index (PI), measured by transcranial Doppler (TCD) ultrasonography, can reflect vascular resistance induced by cerebral small-vessel disease (SVD). We evaluated the value of TCD-derived PI for diagnosing SVD as compared with magnetic resonance imaging (MRI).
Materials and Methods: Fifty-six consecutive cases with SVD (based on MRI) and 48 controls with normal MRI underwent TCD. Based on MRI findings, patients were categorized into five subgroups of preventricular hyperintensity (PVH), deep white matter hyperintensity (DWMH), lacunar, pontin hyperintensity (PH), and PVH+DWMH+lacunar. The sensitivity and specificity of TCD in best PI cut-off points were calculated in each group.
Results: The sensitivity and specificity of TCD in comparison with MRI with best PI cut-off points were as follows: In PVH with PI = 0.83, the sensitivity and specificity was 90% and 98%, respectively. In DWMH with PI = 0.79, the sensitivity and specificity was 75% and 87.5%, respectively. In lacunar with PI = 0.80, the sensitivity and specificity was 73% and 90%, respectively. In PH with PI = 0.69, the sensitivity and specificity was 92% and 87.5%, respectively. And, in PVH+DWMH+lacunar subgroup with PI = 0.83, the sensitivity and specificity was 90% and 96%, respectively.
Conclusions: Increased TCD derived PI can accurately indicate the SVD. Hence, TCD can be used as a non-invasive and inexpensive method for diagnosing SVD, and TCD-derived PI can be considered as a physiologic index of the disease as well.

Keywords

References

1.	Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis 2009;27:493-501.
2.	Mok VC, Lau AY, Wong A, Lam WW, Chan A, Leung H, et al. Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: A five-year longitudinal study. Int J Stroke 2009;4:81-8.
3.	Conijn MM, Kloppenborg RP, Algra A, Mali WP, Kappelle LJ, Vincken KL, et al. Cerebral small vessel disease and risk of death, ischemic stroke, and cardiac complications in patients with atherosclerotic disease: The Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study. Stroke 2011;42:3105-9.
4.	Patel B, Markus HS. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke 2011;6:47-59.
5.	Kidwell CS, el-Saden S, Livshits Z, Martin NA, Glenn TC, Saver JL. Transcranial Doppler pulsatility indices as a measure of diffuse small-vessel disease. J Neuroimaging 2001;11:229-35.
6.	Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med 1974;67:447-9.
7.	Michel E, Zernikow B. Gosling's Doppler pulsatility index revisited. Ultrasound Med Biol 1998;24:597-9.
8.	Mok V, Ding D, Fu J, Xiong Y, Chu WW, Wang D, et al. Transcranial Doppler ultrasound for screening cerebral small vessel disease: A community study. Stroke 2012;43:2791-3.
9.	Heliopoulos I, Artemis D, Vadikolias K, Tripsianis G, Piperidou C, Tsivgoulis G. Association of ultrasonographic parameters with subclinical white-matter hyperintensities in hypertensive patients. Cardiovasc Psychiatry Neurol 2012;2012:616572.
10.	Fisher CM. Lacunar strokes and infarcts: A review. Neurology 1982;32:871-6.
11.	Pullicino P, Ostrow P, Miller L, Snyder W, Munschauer F. Pontine ischemic rarefaction. Ann Neurol 1995;37:460-6.
12.	Faraci FM. Protecting against vascular disease in brain. Am J Physiol Heart Circ Physiol 2011;300:H1566-82.
13.	Harper SL, Bohlen HG, Rubin MJ. Arterial and microvascular contributions to cerebral cortical autoregulation in rats. Am J Physiol 1984;246:H17-24.
14.	Cho SJ, Sohn YH, Kim GW, Kim JS. Blood flow velocity changes in the middle cerebral artery as an index of the chronicity of hypertension. J Neurol Sci 1997;150:77-80.
15.	Lee KY, Sohn YH, Baik JS, Kim GW, Kim JS. Arterial pulsatility as an index of cerebral microangiopathy in diabetes. Stroke 2000;31:1111-5.
16.	Titianova EB, Velcheva IV, Mateev PS. Effects of aging and hematocrit on cerebral blood flow velocity in patients with unilateral cerebral infarctions: A Doppler ultrasound evaluation. Angiology 1993;44:100-6.
17.	Foerstl H, Biedert S, Hewer W. Multiinfarct and Alzheimer-type dementia investigated by transcranial Doppler sonography. Biol Psychiatry 1989;26:590-4.
18.	Bakker SL, de Leeuw FE, de Groot JC, Hofman A, Koudstaal PJ, Breteler MM. Cerebral vasomotor reactivity and cerebral white matter lesions in the elderly. Neurology 1999;52:578-83.
19.	Molina C, Sabín JA, Montaner J, Rovira A, Abilleira S, Codina A. Impaired cerebrovascular reactivity as a risk marker for first-ever lacunar infarction: A case-control study. Stroke 1999;30:2296-301.
20.	Panczel G, Bönöczk P, Voko Z, Spiegel D, Nagy Z. Impaired vasoreactivity of the basilar artery system in patients with brainstem lacunar infarcts. Cerebrovasc Dis 1999;9:218-23.
21.	Puls I, Hauck K, Demuth K, Horowski A, Schliesser M, Dörfler P, et al. Diagnostic impact of cerebral transit time in the identification of microangiopathy in dementia: A transcranial ultrasound study. Stroke 1999;30:2291-5.

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