title: Detection of intracranial arterial stenosis using transcranial color-coded duplex sonography, computed tomographic angiography, and digital subtraction angiography.
abstract: OBJECTIVE
  The aim of this retrospective study was to compare intracranial arterial stenosis in patients with stroke using 3 different methods: transcranial color-coded duplex sonography, computed tomographic (CT) angiography, and digital subtraction angiography in a common clinical practice.
  
  
  METHODS
  Sixty-seven patients (47 male and 20 female; age range, 23-79 years; mean age ± SD, 62.0 ± 9.5 years) were enrolled in this study over 40 months. All patients underwent examinations of the intracranial arteries using transcranial color-coded sonography, CT angiography, and digital subtraction angiography. Findings were divided into 4 groups: normal, mild stenosis (<50%), severe stenosis (50%-99%), and occlusion.
  
  
  RESULTS
  Because of technical reasons or an insufficient bone window, 465 of 536 arterial segments in 67 patients were evaluated; 12 stenotic and 15 occluded segments were detected using digital subtraction angiography. The sensitivity, specificity, positive predictive value, and negative predictive value of transcranial color-coded sonography and CT angiography in comparison with digital subtraction angiography as a reference standard were 88.9%, 94.8%, 51.1%, and 99.3% and 81.5%, 98.7%, 78.6%, and 98.6%, respectively. The agreement between transcranial color-coded sonography and CT angiography was 93.8% (κ = 0.559); between transcranial color-coded sonography and digital subtraction angiography, it was 93.9% (κ = 0.588); and between CT angiography and digital subtraction angiography, it was 96.6% (κ = 0.697).
  
  
  CONCLUSIONS
  Moderate agreement was found between CT angiography, transcranial color-coded sonography, and digital subtraction angiography in the evaluation of intracranial stenosis. Computed tomographic angiography and digital subtraction angiography are sufficient for assessment of the diagnosis.
authors.affiliation: Department of Neurology, Ostrava Medical School and University Hospital, Ostrava, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Roubec
authors.forename: Martin
authors.initials: M
authors.lastname: Kuliha
authors.forename: Tomás
authors.initials: T
authors.lastname: Jonszta
authors.forename: Václav
authors.initials: V
authors.lastname: Procházka
authors.forename: Tána
authors.initials: T
authors.lastname: Fadrná
authors.forename: Michal
authors.initials: M
authors.lastname: Filip
authors.forename: Petr
authors.initials: P
authors.lastname: Kanovsky
authors.forename: Katerina
authors.initials: K
authors.lastname: Langová
authors.forename: Roman
authors.initials: R
authors.lastname: Herzig
authors.forename: David
authors.initials: D
authors.lastname: Skoloudík
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*