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Transcranial Doppler Pulsatility Indices as a Measure of Diffuse Small‐Vessel Disease
Author(s) -
Kidwell Chelsea S.,
ElSaden Suzie,
Livshits Zhanna,
Martin Neil A.,
Glenn Thomas C.,
Saver Jeffrey L.
Publication year - 2001
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2001.tb00039.x
Subject(s) - medicine , transcranial doppler , cardiology , hyperintensity , magnetic resonance imaging , white matter , middle cerebral artery , receiver operating characteristic , ischemia , radiology
Background and Purpose . Elevation in pulsatility indices (PIs) as measured by transcranial Doppler (TCD) have been postulated to reflect downstream increased vascular resistance caused by small‐vessel ischemic disease. Methods . The authors retrospectively compared TCD PIs and magnetic resonance imaging (MRI) manifestations of small‐vessel disease in 55 consecutive patients who underwent TCD studies and brain MRI within 6 months of each other during a 2‐year period. Results . Correlations between TCD middle cerebral artery PIs and MRI measures were as follows: periventricular hyperintensity (PVH) = 0.52 ( P < .0001), deep white matter hyperintensity (DWMH) = 0.54 ( P < .0001), lacunar disease = 0.31 ( P = .02), and combined PVH/DWMH/lacunes = 0.54 ( P < .0001). Correlation between pontine ischemia and vertebrobasilar PIs was 0.46 ( P = .0004). Univariate analysis showed that age, elevated PI, and hypertension strongly correlated with white matter disease measures. After adjusting for these factors in a multivariate Poisson regression analysis, PI remained an independent predictor of white matter disease. Receiver operator curve analyses identified PI cut points that allowed discrimination of PVH with 89% sensitivity and 86% specificity and discrimination of DWMH with 70% sensitivity and 73% specificity. Conclusions . Elevation in PIs as measured by TCD shows strong correlation with MRI evidence of small‐vessel disease. TCD may be a useful physiologic index of the presence and severity of diffuse small‐vessel disease.