Agreement between cervical vascular Doppler ultrasound and high-resolution magnetic resonance imaging for evaluating unilateral extracranial vertebral artery dissection / 中风与神经疾病杂志

ABSTRACT

@#Objective To investigate the agreement between cervical vascular Doppler ultrasound （CDU） and high-resolution magnetic resonance imaging （HRMRI） for the assessment of unilateral extracranial vertebral artery dissection （VAD）. Methods We retrospectively included 132 consecutive patients who presented to the Stroke Center of The First Affiliated Hospital of Soochow University from January 2017 to March 2023 due to clinically suspected cervical artery dissection with sudden pain in the neck and posterior occipital region， neurological dysfunction， and a history of neck massage. They underwent CDU and three dimensional （3D） HRMRI at the same time. The sensitivity， specificity， and accuracy of CDU for assessing unilateral extracranial VAD were analyzed using the Kappa agreement test with 3D HRMRI findings as the reference standard. Furthermore， we examined CDU and HRMRI images for the location and specific signs （including intimal tear， intramural hematoma， double-lumen sign， intraluminal thrombus， dissecting aneurysm， and irregular lumen） of extracranial VAD. The degree of vascular stenosis was calculated by the North American Symptomatic Carotid Endarterectomy Test （NASCET）. The agreement of the two examinations was analyzed using the Kappa test. Results The positive rates of unilateral extracranial VAD assessed by CDU and by HRMRI were 93.2% （123/132） and 93.9% （124/132）， respectively， indicating excellent agreement between the two examinations （Kappa value， 0.87）. For CDU detecting extracranial VAD， the sensitivity was 99.2%， the specificity was 87.5%， and the accuracy was 86.7%. CDU and HRMRI showed excellent agreement in assessing the double-lumen sign， dissecting aneurysm， irregular lumen， lesion location， and the degree of vascular stenosis， with the Kappa values being 1.00， 0.85， 0.88， 0.94， and 0.89， respectively； the two methods showed good agreement for intramural hematoma and intraluminal thrombus， with the Kappa values being 0.79 and 0.80， respectively， and the positive rate of enhanced intramural hematoma detected by HRMRI was 17.7%； the agreement for the intimal tear sign was moderate， with the Kappa value being 0.58. Conclusion CDU can effectively evaluate the imaging signs and the degree of stenosis of extracranial VAD， providing reliable imaging evidence for the early diagnosis and treatment and regular follow-up of VAD.