Extent of spontaneous cross-flow via the anterior communicating artery in steno-occlusive carotid artery disease
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Bibliographic record
Abstract
PURPOSE: Our purpose was to evaluate the agreement of transcranial color-coded duplex sonography (TCCS) measurements and intra-arterial digital subtraction angiography (DSA) findings in determining the extent of spontaneous cross-flow via the anterior communicating artery (AcoA) in patients with internal carotid artery (ICA) stenosis. METHODS: Thirty adult patients with suspected uni- or bilateral high-grade carotid artery stenosis were prospectively examined by DSA and angle-corrected TCCS. The extent of cross-flow was determined considering retrograde flow in the ipsilateral anterior cerebral artery (ACA) and sideto-side differences of the A1-segments of the ACA and middle cerebral arteries (MCAs) by both techniques. Cross-flow was angiographically categorized by means of a four-step scale. DSA findings were correlated with side-to-side differences in mean blood flow velocity as well as flow direction measured by TCCS. RESULTS: Twenty-seven of 30 patients had a uni- or bilateral ICA stenosis of >49%. Excellent agreement between TCCS and DSA was evaluated for the detection of lack (grades 0 and 1) or presence (grades 2 and 3) of reversed flow in the ACA (sensitivity 100%, specificity 93%, positive predictive value 94%). Post hoc analysis of the mean velocities in the ACA and MCA revealed a side-to-side difference of 25 cm/s as a cutting point allowing for definition of a corresponding four-grade scale for ultrasound. However, full agreement, i.e.same grade of cross-flow detected by both techniques, was only found in 17(57%) of 30 cases. CONCLUSIONS: Non-invasive TCCS is reliable for detecting reversed flow in the ACA in patients with ICA stenosis. However, there is only a moderate agreement between angiography and TCCS in quantifying the extent of spontaneous anterior cross-flow because different information on the intracranial hemodynamics may be obtained.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it