颅外段椎动脉扭曲的三维透明成像特征及诊断价值

Characteristics and Diagnostic Value of Three-Dimensional Transparent Ultrasonography in Tortuosity of Extracranial Vertebral Artery

目的探讨三维透明成像（3DUS）对颅外段椎动脉扭曲的诊断价值，并阐述其超声特征。方法对145例患者290条椎动脉进行二维彩色多普勒检查和三维透明成像，并对椎动脉扭曲病例测量扭曲点与直行段血管内径与收缩期峰值血流速度（PSV）、速度时间积分（VTI）、舒张期血流速度（EDV）以及阻力指数（RI），分析比较椎动脉扭曲的二维彩色多普勒超声成像与三维透明成像诊断特征。结果三维透明成像对椎动脉扭曲的检出率（6％），明显高于二维彩色多普勒（2％）。椎动脉扭曲分为横突间扭曲和横突牵拉所致的扭曲。椎动脉扭曲呈多方向性。椎动脉扭曲好发部位于C3-C5段，以C4～C5为甚，占78％。统计分析显示椎动脉扭曲点与直行段比较，扭曲点PSV增高，内径减小，差异显著。3DUS诊断椎动脉扭曲优于二维彩色多普勒。结论三维透明成像能多方位显示椎动脉空间走行，有利于发现不同方向的椎动脉扭曲，提高椎动脉扭曲诊断的准确性，可成为诊断椎动脉扭曲的首选手段。

Objective To assess the diagnostic value of three-dimensional transparent uhrasonography （3DUS） in tortuosity of extracranial vertebral artery and to expound onts 3DUScharacteristics. Methods A total of 290 vertebral arteries in 145 patients were evaluated with two dimensional color Doppler （2DCD） and 3DUS. The inner diameter, peak systolic velocity （PSV）, velocity time integral （VTI）, end diastolic velocity （EDV）, and resistant index （RI） of the tortuous vertebral arteries and their straight parts were measured, the characteristics and diagnostic value of 2DCD and 3DUS were analyzed. Results The detection rate of vertebral arteries by 3DUS （6%） was much higher than that of 2DCD （2%） .The tortuosity of vertebral arteries included that one occurred between processus transversus and the another occurred due to traction between processus transversus. The tortuosity of vertebral arteries bad multi-direction. The most common site of tortuosity of vertebral arteries was at C3-C5 level, especially at C4-C5 （78%）. Compared with the straight parts, the diameter of vertebral arteries on the tortuosity site was decreased and PSV was increased. The sensitivity and specility of 3DUS in diagnosing tortuousity of vertebral arteries was higher than that of two-dimensional flow image. Conclusions 3DUS can provide various directions for spatial trace of vertebral arteries, and is helpful in finding different directional tortuosity of vertebral arteries. 3DUS has high accuracy and is the first choice in diagnosing tortuosity of vertebral arteries.