Evaluation Of Leptomeningeal Collateral Circulation By Transcranial Doppler Sonography In Patients With ICA And MCA Steno-occlusive Disease

Objectives:Take digital subtraction angiography(DSA) as the gold standard, use receiver operating characteristic curve(ROC curve) to evaluate the application value of transcranial Doppler(TCD) in the diagnosis of leptomeningeal collateral channels(LMCs) in the patients with steno-occlusive disease of the internal carotid artery(ICA) and middle cerebral artery(MCA).Methods:Forty-four patients with ICA, MCA or ICA/MCA stenosis or occlusion diagnosed by DSA were enrolled. Use TCD to detect the velocity of anterior cerebral artery(ACA),MCA and posterior cerebral artery(PCA), and the ratio of systolic velocity, diastolic velocity, the average velocity, pulastility index(PI) and resistance index(RI)were defined by velocity in ACA and PCA compared to ispilateral and contralateral anlogs and MCA. The results were compared to the results measured by DSA and the areas of under the ROC curves (AUC), sensitivity and specificity obtained by ROC curve were use to determine the LMCs of ACA and PCA.Results:In the44patients, there’re32patients in the ICA group,7patients in MCA group and5patients in the ICA/MCA group. According the LMCs shown on DSA, the patients divided into no-compensation(n=20),simple ACA compensation(n=15), simple PCA compensation (n=5), and ACA+PCA compensation(n=4) groups. The biggest AUC of detecting the LMCs between ACA and MCA of the ratio of systolic velocity, diastolic velocity, the average velocity, PI and RI were defined by velocity in ACA compared to ispilateral and contralateral ACA and MCA were0.743(95%CI:0.581-0.905),0.707(95%CI:0.530-0.884),0.733(95%CI:0.565-0.900),0.419(95%CI:0.241-0.597) and0.419(95%CI:0.242～0.596), the critical value were1.471,2.435,1.380,1.176and1.126, and the sensitivity and specificity were68.4%/80.0%,57.86%/96.0%,68.4%/84.0%,36.8%/68.0%and31.6%/72.0%. The biggest AUC of detecting the LMCs between PCA and MCA of the ratio of systolic velocity, diastolic velocity, the average velocity, PI and RI were defined by velocity in ACA compared to ispilateral and contralateral PCA and MCA were0.750(95%CI:0.582-0.917),0.726(95%CI:0.524-0.928),0.734(95%CI:0.551-0.918),0.397(95%CI:0.158～0.635) and0.389(95%CI:0.154～0.624), the critical value were1.388,2.027,1.655,1.022and1.014, and the sensitivity and specificity were77.8%/75.0%,55.6%/89.3%,55.6%/85.7%,33.3%/60.7%and33.3%/60.7%.Conclusions:TCD was able to suggest the presence of LMCs by detect the change of velocity of intracranial large vessels in the patients with steno-occlusive disease of the ICA and MCA. The ratio of diastolic velocity has the biggest diagnostic value and the ratio of PI and RI has a low diagnostic value.