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

E. Feldmann, J. L. Wilterdink, A. Kosinski, M. Lynn, M. I. Chimowitz, J. Sarafin, H. H. Smith, F. Nichols, J. Rogg, H. J. Cloft, L. Wechsler, J. Saver, S. R. Levine, C. Tegeler, R. Adams, M. Sloan

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2099-2106
Number of pages8
JournalNeurology
Volume68
Issue number24
DOIs
StatePublished - Jun 2007

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Intracranial Arteriosclerosis
Doppler Ultrasonography
Magnetic Resonance Angiography
Neuroimaging
Stroke
Angiography
Pathologic Constriction
Catheters
Warfarin
Aspirin

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Feldmann, E., Wilterdink, J. L., Kosinski, A., Lynn, M., Chimowitz, M. I., Sarafin, J., ... Sloan, M. (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

The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. / Feldmann, E.; Wilterdink, J. L.; Kosinski, A.; Lynn, M.; Chimowitz, M. I.; Sarafin, J.; Smith, H. H.; Nichols, F.; Rogg, J.; Cloft, H. J.; Wechsler, L.; Saver, J.; Levine, S. R.; Tegeler, C.; Adams, R.; Sloan, M.

In: Neurology, Vol. 68, No. 24, 06.2007, p. 2099-2106.

Research output: Contribution to journalArticle

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 2007, 'The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial', Neurology, vol. 68, no. 24, pp. 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;68(24):2099-2106. https://doi.org/10.1212/01.wnl.0000261488.05906.c1
Feldmann, E. ; Wilterdink, J. L. ; Kosinski, A. ; Lynn, M. ; Chimowitz, M. I. ; Sarafin, J. ; Smith, H. H. ; Nichols, F. ; Rogg, J. ; Cloft, H. J. ; Wechsler, L. ; Saver, J. ; Levine, S. R. ; Tegeler, C. ; Adams, R. ; Sloan, M. / The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. In: Neurology. 2007 ; Vol. 68, No. 24. pp. 2099-2106.
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T1 - The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial

AU - Feldmann, E.

AU - Wilterdink, J. L.

AU - Kosinski, A.

AU - Lynn, M.

AU - Chimowitz, M. I.

AU - Sarafin, J.

AU - Smith, H. H.

AU - Nichols, F.

AU - Rogg, J.

AU - Cloft, H. J.

AU - Wechsler, L.

AU - Saver, J.

AU - Levine, S. R.

AU - Tegeler, C.

AU - Adams, R.

AU - Sloan, M.

PY - 2007/6

Y1 - 2007/6

N2 - 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.

AB - 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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