彩色多普勒超声诊断急性脑梗死患者颈动脉硬化病变价值的探讨

Color Doppler ultrasound of carotid arteriosclerosis with acute cerebral infarction

目的评价彩色多普勒超声（color Doppler ultrasound，CDU）在诊断急性脑梗死患者颈动脉硬化病变的价值。方法应用CDU对30例急性脑梗死患者颅外段颈动脉血管检测，每例患者均同时行数字减影血管造影（DSA）检查，并将2种检查方法的结果进行一致性检验（Kappa检验）。结果以DsA检查结果为金标准，得出了二维彩色超声诊断颈动脉中重度以上狭窄及闭塞的敏感度、特异度及准确度分别为95．5％、94．7％、95．0％，CDU频谱诊断中重度以上狭窄及闭塞的敏感度、特异度及准确度分别为77．3％、97．4％、90．0％。一致性检验（Kappa检验）结果表明CDU和DSA2种方法的检查结果的一致性良好，CDU形态学测定与DSA的Kappa值为0．787，CDU血流动力学测定与DSA的Kappa值为0．669。结论在评估狭窄程度方面，CDU与DSA一致性好，对于大多数中、重度以上的狭窄。CDU可以取代有创性DSA，甚至仅凭超声检查结果就能对70％～99％狭窄病例的诊断治疗方案进行选择。

Objective To evaluate the application of color Doppler ultrasound （CDU） on the carotid arteriosclerosis with acute cerebral infarction. Methods Thirty cases of carotid arteriosclerosis with acute cerebral infarction were investigated using CDU, and the ultrasound findings were compared with those of digital subtraction arteriography （DSA） which served as the diagnosis gold standard method. Kappa test was performed between the results of CDU and DSA. Results The sensitivity,specificity and accuracy of B-mode and color image in the diagnosis of above the moderate degree carotid artery stenosis and occlusion were 95.5%,94.7% and 95.0% ,respectively. And CDU for above the moderate degree of stenosis, the sensitivity, specificity and accuracy were 77.3%, 97.4% and 90.0%,respectively. Kappa test showed the agreement between CDU and DSA for the diagnosis of carotid artery stenosis was good, CDU morphologic mensurate Kappa ： 0.787, CDU hemodynamics mensurate Kappa ： 0. 669. Conclusion The agreement between CDU and DSA in the evalution of carotid artery stenosis is good. For the most of moderate and serious degrees of stenosis,CDU is a substitution for DSA. Additionally, the therapeutic regimen could be decided on the basis of the findings of CDU for 70%--99% degree of stenosis.