经颅多普勒超声与磁共振血管成像评估颅内大动脉血管腔及血流动力学变化的比较(英文)

Comparison of intracranial large artery vascular trunks and hemodynamic change with transcranial Doppler ultrasound and magnetic resonance angiography

背景:血管造影虽为诊断脑血管病的“金标准”,因其有创性不能广泛应用,经颅多普勒超声和头部磁共振血管成像均为无创检查,可用于颅内大动脉血管腔及血流动力学的评估。目的:探讨经颅多普勒超声评估缺血性脑血管病时血流动力学变化的可靠性及与磁共振血管成像的相关性。设计:以患者为观察对象,病例分析。单位:哈尔滨医科大学第一临床医学院神经内科。对象:以2001-04/2002-02哈尔滨医科大学第一临床医学院神经内科收治的脑卒中患者45例为观察对象,所有患者经CT证实为缺血性脑血管病,且对实验知情同意。方法:应用TC-2021经颅多普勒超声仪及VISART1.5T超导MR装置,对45例患者行经颅多普勒超声与磁共振血管成像检查,两次检查相隔时间为1～15d。观察所检大脑中动脉、颈内动脉末端、大脑前动脉、大脑后动脉、椎动脉、基底动脉血管的血流动力学及管腔形态的变化。主要观察指标:①经颅多普勒超声和磁共振血管成像检查患者颅内血管腔和血流动力学结果的相关性。②以磁共振血管成像为标准,比较经颅多普勒超声检查的特异性,敏感性,假阳性,假阴性及符合率。结果:45例患者全部进入结果分析。①经颅多普勒超声和磁共振血管成像检测结果相关性:理论值:Tmin=9.91;χ2=107.92,P<0.005,可认为两者检出率结果有关;经颅多普勒超声检出率为19.06%,磁共振血管成像检出率为15.25%,两者检出阳性率有差别(χ2=3.93,P<0.05)。②以磁共振血管成像为标准,比较经颅多普勒超声发现相应血管病变数,得出诊断异常血管的特异性为94.22%、敏感性为78.10%、假阳性为7.46%,假阴性为23.31%及符合率为89.36%。结论:经颅多普勒超声诊断缺血性脑血管病脑血管异与磁共振血管成像相符性较高,它能准确判定所探及血管功能状态,能较早而敏感反映脑血流动力学的变化。而磁共振血管成像则可直接显示血管形态的改变,两者结合可提高诊断的敏感性和特异性。

BACKGROUND： Although angiography is the goht standard for the diagnosis of cerebrovascular disease, it cannot be used widely because of its lraumalolaxis. Transcranial Doppler uhrasound （TCD） and MRA are both non-invasive examinations, whieh can be used to evaluate inlracranial large artery vascular trunks and hemodynamies. OBJECTIVE： To investigate the reliability of diagnosis with TCD on hemodynamie ehanges of ischemie eercbrovaseular disease （ICVD） and the relativity between TCD and MRA. DESIGN： Case analysis based on patients. SETTING： Neurological Department of the First Affiliated Clinical Hospital,Harbin Medical University. PARTICIPANTS： From April 2001 to February 2002,totally 45 patients with stroke,selected from outpatients and inpatients of Neurological Department of First Affiliated Clinieal Hospital of Harbin Medical University, examined by CT, to be told the fael and aceepled, were taken part in the study. METHODS： Patients were examined with TC-2021 TCD instrument produced by German EME Corporation and VISART1.5T superconduet MR instrument produced by Toshiba. Totally 45 patients had TCD and MRI examinations, and the alternation between two examinations was 1 to 15 days. The hemodynamies and morphologieal changes were observed including middle eerebral artery （MCA）. end of internal carotid artery （ICA）, anterior cerebral artery （ACA）, posterior cerebral artery （PCA）, basal artery （BA）, and vertebral artery （VA）. MAIN OUTCOME MEASURES： ① Correlation between intraeranial large artery vascular trunks and hemodynamic results with TCD and MRA; ② Considering MRA as the standard, to compare the specificity, sensitivity, false positive and false negative with TCD with those of MRA. RESULTS： All 45 patients entered /he final analysis. ① Relativity of TCD and MRA： Theory data was Tmin=9.91; X^2=107.92, P 〈 0.005, it was considered that the results with the rate of TCD were related with that of MRA. The detection rate of TCD was 19.06%, and that of MRA was 15.25%. There were signifieanl differences between the detection rate of TCD and that of MRA （X^2=3.93, P 〈 0.05）.② Considering MRA as the standard, the sensibility of diagnosing abnormal vessels by TCD was 78.10%, speeifieity 94.22%, false positive 7.46%, false negative 23.31%, and the coineidenee rate 89.36%. CONCLUSION： TCD can assess exactly the functional status of the vessels. It can also reflect early and sensitively the change of hemodynamics of cerebral blood flow. While MRA can display the change of vascular appearance directly so that the combination of TCD and MRA will be improve sensibility and specifieily of diagnosis.