机构：[1]Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[2]Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[3]Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA[4]Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA[5]NovaSignal, Los Angeles, California, USA[6]Division of Neurocritical Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA[7]Department of Neurology, Foshan Sanshui District People’s Hospital, Foshan, China[8]Department of Neurology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas, USA[9]Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China神经科系统神经外科首都医科大学宣武医院[10]Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[11]Status Epilepticus Division, Marinus Pharmaceuticals, Radnor, Pennsylvania, USA
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.
基金：
National Institutes of Health; National
Institute of Neurological Disorders and Stroke,
Grant/Award Number: R25 NS065743;
Society of Vascular and Interventional
Neurology; Heitman Foundation for Stroke
语种：
外文
WOS：
PubmedID：
中科院(CAS)分区：
出版当年[2023]版：
大类|4 区医学
小类|4 区临床神经病学4 区神经成像4 区核医学
最新[2023]版：
大类|4 区医学
小类|4 区临床神经病学4 区神经成像4 区核医学
JCR分区：
出版当年[2022]版：
Q3CLINICAL NEUROLOGYQ3NEUROIMAGINGQ3RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
最新[2023]版：
Q2RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGINGQ3CLINICAL NEUROLOGYQ3NEUROIMAGING
第一作者机构：[1]Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[2]Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[3]Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA[*1]Department of Neurology, Massachusetts General Hospital,Harvard Medical School, 175 Cambridge St, Suite 300, Boston, MA 02114, USA.
通讯作者：
通讯机构：[1]Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[2]Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA[3]Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA[*1]Department of Neurology, Massachusetts General Hospital,Harvard Medical School, 175 Cambridge St, Suite 300, Boston, MA 02114, USA.
推荐引用方式(GB/T 7714)：
Regenhardt Robert W.,Nolan Neal M.,Das Alvin S.,et al.Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease[J].JOURNAL OF NEUROIMAGING.2024,34(3):348-355.doi:10.1111/jon.13197.
APA：
Regenhardt, Robert W.,Nolan, Neal M.,Das, Alvin S.,Mahajan, Rahul,Monk, Andrew D....&Vaitkevicius, Henrikas.(2024).Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease.JOURNAL OF NEUROIMAGING,34,(3)
MLA：
Regenhardt, Robert W.,et al."Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease".JOURNAL OF NEUROIMAGING 34..3(2024):348-355
