Velocity Curvature Index: a Novel Diagnostic Biomarker for Large Vessel Occlusion

Autor: Robert B. Hamilton, Christian Devlin, Thomas Devlin, Seth J. Wilk, Michael O'Brien, Mina Ranjbaran, Corey M. Thibeault, Samuel G. Thorpe, Nicolas Canac
Jazyk: angličtina
Rok vydání: 2018
Předmět:
0301 basic medicine
Male
medicine.medical_specialty
Middle Cerebral Artery
Computed Tomography Angiography
Ultrasonography
Doppler
Transcranial
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine.artery
Occlusion
Ultrasound
Medicine
Humans
Diagnosis
Computer-Assisted
Stroke
Aged
Ischemic stroke
medicine.diagnostic_test
Receiver operating characteristic
business.industry
General Neuroscience
Transcranial Doppler
Signal Processing
Computer-Assisted
Middle Aged
medicine.disease
030104 developmental biology
Cerebral blood flow
ROC Curve
Cerebrovascular Circulation
Angiography
Cerebral hemisphere
Cardiology
cardiovascular system
Diagnostic imaging
Original Article
Female
Neurology (clinical)
Internal carotid artery
Cardiology and Cardiovascular Medicine
business
Large vessel occlusion
030217 neurology & neurosurgery
Biomarkers
Zdroj: Translational Stroke Research
ISSN: 1868-601X
1868-4483
Popis: Despite being a conveniently portable technology for stroke assessment, Transcranial Doppler ultrasound (TCD) remains widely underutilized due to complex training requirements necessary to reliably obtain and interpret cerebral blood flow velocity (CBFV) waveforms. The validation of objective TCD metrics for large vessel occlusion (LVO) represents a first critical step toward enabling use by less formally trained personnel. In this work, we assess the diagnostic utility, relative to current standard CT angiography (CTA), of a novel TCD-derived biomarker for detecting LVO. Patients admitted to the hospital with stroke symptoms underwent TCD screening and were grouped into LVO and control groups based on the presence of CTA confirmed occlusion. Velocity curvature index (VCI) was computed from CBFV waveforms recorded at multiple depths from the middle cerebral arteries (MCA) of both cerebral hemispheres. VCI was assessed for 66 patients, 33 of which had occlusions of the MCA or internal carotid artery. Our results show that VCI was more informative when measured from the cerebral hemisphere ipsilateral to the site of occlusion relative to contralateral. Moreover, given any pair of bilateral recordings, VCI separated LVO patients from controls with average area under receiver operating characteristic curve of 92%, which improved to greater than 94% when pairs were selected by maximal velocity. We conclude that VCI is an analytically valid candidate biomarker for LVO diagnosis, possessing comparable accuracy, and several important advantages, relative to current TCD diagnostic methodologies.
Databáze: OpenAIRE
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