Journal of Neurosciences in Rural Practice
Year : 2015  |  Volume : 6  |  Issue : 3  |  Page : 336-338

Disappointing reliability of pulsatility indices to identify candidates for magnetic resonance imaging screening in population-based studies assessing prevalence of cerebral small vessel disease

1 School of Medicine, Universidad Espiritu Santo - Ecuador, Ecuador
2 Department of Gastroenterology, Vanderbilt University, Nashville, TN, USA
3 Department of Neurology, Hospital Medica Sur, Mexico City, Mexico
4 Mayo Clinic College of Medicine, Sleep Disorder Center, Jacksonville, Fl, USA
5 Community Center, the Atahualpa Project, Atahualpa, Ecuador

Correspondence Address:
Oscar H. Del Brutto
School of Medicine, Universidad Espíritu Santo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-3147.158760

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Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where magnetic resonance imaging (MRI) is not available. Hospital-based studies in high-risk or stroke patients have found an association between the pulsatility index (PI) of intracranial arteries - as derived from transcranial Doppler (TCD) - and white matter hyperintensities (WMH) of presumed vascular origin. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of SVD. Methods: A representative sample of stroke-free Atahualpa residents aged ≥65 years investigated with MRI underwent TCD. Using generalized linear models, we evaluated whether the PI of major intracranial arteries correlate with WMH (used as a proxy of diffuse SVD), after adjusting for demographics and cardiovascular risk factors. Results: Out of 70 participants (mean age 70.6 ± 4.6 years, 57% women), 28 (40%) had moderate-to-severe WMH. In multivariate models, there were no differences across categories of WMH in the mean PI of middle cerebral arteries (1.10 ± 0.16 vs. 1.22 ± 0.24, β: 0.065, 95% confidence interval (CI): −0.084-0.177, P = 0.474) or vertebrobasilar arteries (1.11 ± 0.16 vs. 1.29 ± 0.27, β: 0.066, 95% CI: −0.0024-0.156, P = 0.146). Conclusions: Cerebral PI should not be used to identify candidates for MRI screening in population-based studies assessing the burden of SVD.

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