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The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial.

Publication ,  Journal Article
Feldmann, E; Wilterdink, JL; Kosinski, A; Lynn, M; Chimowitz, MI; Sarafin, J; Smith, HH; Nichols, F; Rogg, J; Cloft, HJ; Wechsler, L; Saver, J ...
Published in: Neurology
June 12, 2007

BACKGROUND: Transcranial Doppler ultrasound (TCD) and magnetic resonance angiography (MRA) can identify intracranial atherosclerosis but have not been rigorously validated against the gold standard, catheter angiography. The WASID trial (Warfarin Aspirin Symptomatic Intracranial Disease) required performance of angiography to verify the presence of intracranial stenosis, allowing for prospective evaluation of TCD and MRA. The aims of Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial were to define abnormalities on TCD/MRA to see how well they identify 50 to 99% intracranial stenosis of large proximal arteries on catheter angiography. STUDY DESIGN: SONIA standardized the performance and interpretation of TCD, MRA, and angiography. Study-wide cutpoints defining positive TCD/MRA were used. Hard copy TCD/MRA were centrally read, blind to the results of angiography. RESULTS: SONIA enrolled 407 patients at 46 sites in the United States. For prospectively tested noninvasive test cutpoints, positive predictive values (PPVs) and negative predictive values (NPVs) were TCD, PPV 36% (95% CI: 27 to 46); NPV, 86% (95% CI: 81 to 89); MRA, PPV 59% (95% CI: 54 to 65); NPV, 91% (95% CI: 89 to 93). For cutpoints modified to maximize PPV, they were TCD, PPV 50% (95% CI: 36 to 64), NPV 85% (95% CI: 81 to 88); MRA PPV 66% (95% CI: 58 to 73), NPV 87% (95% CI: 85 to 89). For each test, a characteristic performance curve showing how the predictive values vary with a changing test cutpoint was obtained. CONCLUSIONS: Both transcranial Doppler ultrasound and magnetic resonance angiography noninvasively identify 50 to 99% intracranial large vessel stenoses with substantial negative predictive value. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis trial methods allow transcranial Doppler ultrasound and magnetic resonance angiography to reliably exclude the presence of intracranial stenosis. Abnormal findings on transcranial Doppler ultrasound or magnetic resonance angiography require a confirmatory test such as angiography to reliably identify stenosis.

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Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

June 12, 2007

Volume

68

Issue

24

Start / End Page

2099 / 2106

Location

United States

Related Subject Headings

  • United States
  • Ultrasonography, Doppler, Transcranial
  • Stroke
  • Prospective Studies
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Magnetic Resonance Angiography
  • Intracranial Arteriosclerosis
 

Citation

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Feldmann, E., Wilterdink, J. L., Kosinski, A., Lynn, M., Chimowitz, M. I., Sarafin, J., … Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators, . (2007). The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology, 68(24), 2099–2106. https://doi.org/10.1212/01.wnl.0000261488.05906.c1
Feldmann, E., J. L. Wilterdink, A. Kosinski, M. Lynn, M. I. Chimowitz, J. Sarafin, H. H. Smith, et al. “The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial.Neurology 68, no. 24 (June 12, 2007): 2099–2106. https://doi.org/10.1212/01.wnl.0000261488.05906.c1.
Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, et al. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology. 2007 Jun 12;68(24):2099–106.
Feldmann, E., et al. “The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial.Neurology, vol. 68, no. 24, June 2007, pp. 2099–106. Pubmed, doi:10.1212/01.wnl.0000261488.05906.c1.
Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, Smith HH, Nichols F, Rogg J, Cloft HJ, Wechsler L, Saver J, Levine SR, Tegeler C, Adams R, Sloan M, Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology. 2007 Jun 12;68(24):2099–2106.

Published In

Neurology

DOI

EISSN

1526-632X

Publication Date

June 12, 2007

Volume

68

Issue

24

Start / End Page

2099 / 2106

Location

United States

Related Subject Headings

  • United States
  • Ultrasonography, Doppler, Transcranial
  • Stroke
  • Prospective Studies
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Magnetic Resonance Angiography
  • Intracranial Arteriosclerosis