title: Relationship between flow diversion on transcranial Doppler sonography and leptomeningeal collateral circulation in patients with middle cerebral artery occlusive disorder.
abstract: BACKGROUND
  Flow diversion (FD) has been considered as indirect evidence of intracranial artery occlusion, and it was associated with early improvement in patients with MCA occlusion. It is not known whether FD can represent leptomeningeal collateral circulation or not in patients with middle cerebral artery (MCA) occlusive disorder.
  
  
  METHODS
  FD was defined by increased velocity (>30%) in anterior or posterior cerebral artery (ACA, PCA) compared to contralateral analogs artery in patients with MCA occlusive disorder. The leptomeningeal collateral channel (LMC) was identified using digital subtraction angiography.
  
  
  RESULTS
  A total of 51 patients were enrolled in this analysis. Transcranial Doppler (TCD) showed a FD in 47% (24) of patients. Twenty-three patients had FD in ACA, and 1 patient in PCA. LMC was identified in 41% (21) of patients. Sensitivity of FD for leptomeningeal collateral circulation was 81%, specificity 76.7%, positive predictive value 70.8%, and negative predictive value 85.2%. Presence of FD showed good correlation with presence of LMCs in patients with MCA stenosis (r= .568, P= .00)
  
  
  CONCLUSIONS
  FD on TCD suggests the presence of leptomeningeal collateral circulation in patients with MCA occlusive disorder.
authors.affiliation: Department of Neurology, School of Medicine, Wonkwang University, South Korea. yosik@wonkwang.ac.kr
authors.forename: Yosik
authors.initials: Y
authors.lastname: Kim
authors.forename: Dae-Soo
authors.initials: DS
authors.lastname: Sin
authors.forename: Hyun-Young
authors.initials: HY
authors.lastname: Park
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
mesh_terms: D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D016009:Chi-Square Distribution; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D008297:Male; D008578:Meninges / Q000098:blood supply / Q000000981:diagnostic imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D017585:Ultrasonography, Doppler, Transcranial