title: Accuracy of color-Doppler in the quantification of proximal vertebral artery stenoses.
abstract: BACKGROUND
  Vertebrobasilar (VB) strokes appear to have the same causes as carotid strokes. Obstructive lesions of proximal vertebral arteries probably occur in about 30% of stroke patients.
  
  
  OBJECTIVE
  Our aim was to assess the validity of color Doppler sonography compared to selective intra-arterial angiography in the quantification of proximal vertebral artery stenoses.
  
  
  METHODS
  A prospective blind study of 316 vertebral arteries was undertaken between 1996 and 1998. One hundred and fifty-eight patients with cerebrovascular disorders without cerebral hemorrhage were studied consecutively by frequency or amplitude color Doppler flow imaging and intra-arterial angiography. The lesions were quantified by morphological and hemodynamic criteria and classified into 6 groups: 0% 207 arteries; 1-29% 32 arteries; 30-49% 29 arteries; 50-69% 13 arteries; 70-99% 23 arteries; 100% 12 arteries.
  
  
  RESULTS
  Ten of the 12 occlusions were identified, the 2 false-negatives were due to 2 revascularized vessels. Moderate stenoses (<50%) were differentiated from tight stenoses (>50%) using hemodynamic criteria. The majority of false-negative stenoses (38) in the different groups were related to intrathoracic or very deep origin of the artery, anechogenic stenosis or a tortuous vessel. Stenoses greater than 70% were diagnosed in 71% of cases with a specificity of 99%. The kappa value was 0.80.
  
  
  CONCLUSIONS
  Duplex sonography should be proposed first in VB attacks or stroke to detect and quantify vertebral artery stenoses for surgery and angioplasty.
authors.affiliation: Department of Neurology, CHU, Angers, France.
authors.forename: J M
authors.initials: JM
authors.lastname: de Bray
authors.forename: A
authors.initials: A
authors.lastname: Pasco
authors.forename: F
authors.initials: F
authors.lastname: Tranquart
authors.forename: X
authors.initials: X
authors.lastname: Papon
authors.forename: C
authors.initials: C
authors.lastname: Alecu
authors.forename: B
authors.initials: B
authors.lastname: Giraudeau
authors.forename: F
authors.initials: F
authors.lastname: Dubas
authors.forename: J
authors.initials: J
authors.lastname: Emile
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D004311:Double-Blind Method; D005189:False Positive Reactions; D006801:Humans; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D014711:Vertebral Artery / Q000000981:diagnostic imaging*