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(Stroke. 2001;32:1811.)
© 2001 American Heart Association, Inc.

Original Contributions

Cerebrovascular Reserve in Patients With Carotid Occlusive Disease Assessed by Stable Xenon-Enhanced CT Cerebral Blood Flow and Transcranial Doppler

Ronda R. Pindzola, PhD; Jeffrey R. Balzer, PhD; Edwin M. Nemoto, PhD; Steven Goldstein, MD Howard Yonas, MD

From the Departments of Neurological Surgery (R.R.P., J.R.B., E..N., H.Y.), Neurology (S.G.), and Radiology (H.Y.), University of Pittsburgh Medical Center, Pittsburgh, Penn.

Correspondence to Ronda R. Pindzola, PhD, Department of Neurological Surgery, University of Pittsburgh Medical Center, PUH Suite B-400, 200 Lothrop St, Pittsburgh, PA 15213. E-mail pindzola{at}neuronet.pitt.edu

Background and Purpose—— Cerebrovascular reserve (CVR) by both transcranial Doppler ultrasonography (TCD) and quantitative cerebral blood flow (CBF) can identify subgroups of patients at increased risk for stroke. A direct comparison of CVR measurements obtained with both technologies in patients with cerebrovascular occlusive disease is lacking.

Methods—— CVRs before and after acetazolamide administration (1 g IV) were measured by TCD insonation of the middle cerebral artery (MCA) and CBF obtained with stable xenon CT (Xe/CT) in 38 patients with carotid occlusive disease. Sensitivity/specificity calculations were based on 2 Xe/CT MCA values: an average over 4 levels and the level with the lowest percent change in CBF. Compromised CVR was defined as no reactivity or a decrease in reactivity.

Results—— Using the analysis of the systolic TCD, we found that velocity changes compared with the average Xe/CT MCA CVR showed a sensitivity of 33%, specificity of 90.6%, positive predictive value of 54.5%, and negative predictive value of 80%. The sensitivity of TCD compared with the lowest Xe/CT CBF CVR was 35.5%, specificity and positive predictive values were 100%, and negative predictive value was 66.7%. The index of validity was between 72% and 76%.

Conclusions—— TCD is much less sensitive than Xe/CT CBF in identifying patients with compromised CVR. This may be a result of the inability of TCD to identify patients with compromised reserves when their MCA blood flow comes from collateral sources. The lack of correlation between TCD and Xe/CT CBF for identifying patients with compromised CVR should be considered when stroke risk assessments are made by TCD.

Key Words: acetazolamide • carotid artery occlusion • cerebral blood flow • ultrasonography, Doppler, transcranial • vasoreactivity

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