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To the Editor:
We congratulate Feldmann et al. on their study concerning the Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial.1 Although the negative predictive value (NPV) for the magnetic resonance angiography (MRA) and transcranial Doppler (TCD) were high (91% for MRA and 86% for TCD), the positive predictive value (PPV) for both tests were disappointingly low (59% and 36%, respectively).
We conducted a trial comparing aspirin to anticoagulants in the prevention of vascular events in patients with symptomatic stenosis of the middle cerebral artery (MCA).2 We included patients only when two of the three noninvasive (MRA, TCD, or CT angiography) tests indicated the diagnosis of MCA stenosis greater than 50%. It would be beneficial to reanalyze the SONIA data comparing the diagnostic results of MRA and TCD with conventional …
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