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Transcranial color‐coded duplex sonography reliably identifies intracranial vasculopathy in adult patients with sickle cell disease
Author(s) -
Edjlali Myriam,
GobinMetteil MariePierre,
Mélé Nicolas,
Maïer Benjamin,
Habibi Anoosha,
Kauv Paul,
Hosseini Hassan,
Mas JeanLouis,
Oppenheim Catherine,
Galactéros Frédéric,
Bartolucci Pablo,
Calvet David
Publication year - 2021
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.26215
Subject(s) - medicine , transcranial doppler , magnetic resonance angiography , radiology , occlusion , stroke (engine) , stenosis , magnetic resonance imaging , duplex ultrasonography , vascular disease , cardiology , mechanical engineering , engineering
In order to prevent stroke, screening for disease‐related intracranial vasculopathy using Doppler ultrasound is recommended in sickle‐cell disease (SCD) children. How to screen such vasculopathy in adults remains largely unknown. The objective of this study was to assess whether transcranial color‐coded duplex sonography (TCCD) is sensitive and specific enough to identify SCD adult patients with vasculopathy, compared with magnetic resonance angiography (MRA). Sickle cell disease adults followed in referral centers at high risk of vasculopathy were included in this study. Transcranial color‐coded duplex sonography examination and 3‐D time‐of‐flight MRA were performed on the same day. On MRA, vasculopathy was defined by the presence of at least one ≥50% arterial stenosis. On TCCD, vasculopathy was defined by a time‐averaged mean of the maximum velocity (TAMx) stenotic/prestenotic ratio ≥ 3, an occlusion, or a Moyamoya pattern. Vasculopathy was also considered as present when TAMx ratio could not be calculated because of the presence of severe cervical lesions. Among 80 included patients, quality of MRA was insufficient in three patients. Among the 38 patients with vasculopathy on MRA, 37 had a vasculopathy according to TCCD criteria: TAMx ratio ≥ 3 or intracranial occlusion in 33 patients and cervical lesion in four patients. A Moyamoya pattern was identified with TCCD in all 17 patients with Moyamoya on MRA. Sensitivity and specificity of TCCD to identify patients with ≥50% vasculopathy on MRA were (n = 37/38) 97% and (n = 28/34) 82%, respectively. Positive and negative predictive values were (n = 37/43) 86% and (n = 28/29) 97%, respectively. Note, TCCD may be used to identify SCD adult patients with vasculopathy.