闭塞性脑血管病经颅多谱勒超声和脑血管造影的比较

A study of TCD in comparison with DSA for the diagnoses of occlusive and stenotic disorders of carotid and intracranial arteries

观察经颅多谱勒超声（ＴＣＤ）对颈部和颅内血管狭窄诊断的可靠性。方法收集患者１１０例，分为非脑血管病（１５例）、非闭塞性脑血管病（１８例）、闭塞性脑血管病（７７例）三组。分别用２Ｈｚ和４Ｈｚ多谱勒探头检查颅脑和颈部大动脉的血流速度，然后做数字减影血管造影（ＤＳＡ）。结果在闭塞性脑血管病组共检查血管７７１条，多谱勒超声发现狭窄血管１２４条，６４７条正常，其中１１３条与ＤＳＡ所见一致，ＤＳＡ发现另外１８条狭窄的血管。统计结果显示，ＴＣＤ诊断血管狭窄的敏感性是８６％，特异性达９８％，假阳性是８％，假阴性是３％。ＴＣＤ漏诊和误诊的血管狭窄，在颅内、颅外分布无显著差异。在非脑血管病组和非闭塞性脑血管病组的３３人中，ＴＣＤ无１例误诊为狭窄。结论ＴＣＤ对诊断颅内和颈部严重狭窄血管具有较高的特异性和敏感性。对大脑中动脉、颈内动脉近端和远端，以及锁骨下动脉狭窄诊断的可靠性较高。不易与其他疾病相混淆，可作为ＤＳＡ检查的筛选手段。

Objective To evaluate the transcranial Doppler (TCD) as a screening modality for intra and extra cranial arterial disorders in comparison with the use of digital subtraction angiography (DSA). Methods One hundred and ten patients were collected and divided into three groups. The patients of group A were free of cerebrovascular disorders, of group B had non occlusive cerebrovascular disorders and the 77 patients of group C had occlusive cerebrovascular disorders. All the patients underwent TCD, carotid Doppler and DSA examinations.Results The cervical and TCD ultrasound examinations suggested the presence of stenosis or occlusion in 124 arteries, 113 of them being confirmed with DSA. The sensitivity of the Doppler ultrasound examinations for arterial stenosis was 8.6%. The specificity was 98%. None was diagnosed with the Doppler ultrasound as arterial stenosis in those patients free of cerebraovascular disorders or in those with non occlusive cerebrovascular disorders. Conclusion TCD and carotid Doppler ultrasound examination would be relatively quite reliable in evaluating the intra and extra cranial, significant arterial stenosis. It would be particularly useful in the patients with severe carotid stenosis to detect the intracranial circulation and in the patients with intracranial stenosis.