{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:42:46Z","timestamp":1765233766864,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,30]],"date-time":"2024-03-30T00:00:00Z","timestamp":1711756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R25 NS065743"],"award-info":[{"award-number":["R25 NS065743"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuroimaging"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>Thresholds for abnormal transcranial Doppler\u00a0cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with\u00a0cerebrovascular disease. Using a real\u2010world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation.\u00a0The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2\u00a0SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean\u00b1SD\u00a0age 55\u00b116\u00a0years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean\u00b1SD CO2R for the unaffected side was 1.86\u00b10.53%, defining abnormal CO2R as &lt;0.80%. Mean\u00b1SD CO2R for the affected side was 1.27\u00b10.90%. The\u00a0CO2R threshold predicted abnormal acetazolamide single\u2010photon emission computed tomography (SPECT) (Sn\u00a0=\u00a0.73, Sp\u00a0=\u00a0.79), CT\/MRI perfusion abnormality (Sn\u00a0=\u00a0.42, Sp\u00a0=\u00a0.77), infarction on MRI (Sn\u00a0=\u00a0.45, Sp\u00a0=\u00a0.76), and pressure\u2010dependent exam (Sn\u00a0=\u00a0.50, Sp\u00a0=\u00a0.76). For the unaffected side, mean\u00b1SD VMR was 39.5\u00b115.8%, defining abnormal VMR as &lt;7.9%. For the affected side, mean\u00b1SD VMR was 26.5\u00b117.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn\u00a0=\u00a0.46, Sp\u00a0=\u00a0.94), infarction on MRI (Sn\u00a0=\u00a0.27, Sp\u00a0=\u00a0.94), and pressure\u2010dependent exam (Sn\u00a0=\u00a0.31, Sp\u00a0=\u00a0.90).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is &lt;0.80% and VMR is &lt;7.9%. Noninvasive\u00a0CVR may aid in diagnosing and risk stratifying patients with\u00a0stenosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jon.13197","type":"journal-article","created":{"date-parts":[[2024,3,30]],"date-time":"2024-03-30T07:44:51Z","timestamp":1711784691000},"page":"348-355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-3484","authenticated-orcid":false,"given":"Robert W.","family":"Regenhardt","sequence":"first","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurosurgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal M.","family":"Nolan","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-977X","authenticated-orcid":false,"given":"Alvin S.","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Beth Israel Deaconess Medical Center, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9613-2870","authenticated-orcid":false,"given":"Rahul","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D.","family":"Monk","sequence":"additional","affiliation":[{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"NovaSignal  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah L.","family":"LaRose","sequence":"additional","affiliation":[{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Migdady","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Neurocritical Care Montefiore Medical Center, Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yimin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Foshan Sanshui District People's Hospital  Foshan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faheem","family":"Sheriff","sequence":"additional","affiliation":[{"name":"Department of Neurology Texas Tech University Health Sciences Center, Paul L. 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