不同血管影像检查对颈内动脉TIA诊断的对比研究

The comparative study of different vascular imaging for diagnosis of intercranial artery TIA

目的研究颈内动脉TIA的临床特征、颈动脉狭窄的特点、以及经颅多普勒(transcranial Doppler ul-trasound,TCD)、CT血管造影(computed tomographic angiography,CTA)和数字减影血管造影(digital subtraction angi-ography,DSA)对颈动脉狭窄的评估价值。方法选取56例颈内动脉TIA患者行全脑血管造影(DSA)检查,结合DSA检查结果分析其临床及颈动脉狭窄特点;同时对46例患者进行了TCD检查,54例患者进行了CTA检查,应用Kappa检验分析TCD和CTA检查的敏感性、特异性和符合率。结果7.1%的患者临床表现为不典型的颈内动脉TIA;76.8%患者存在血管狭窄;7.1%的颈内动脉患者病变血管为椎基底动脉;86.1%的血管狭窄为中重度以上,以单纯的颅内动脉狭窄(48.8%)为主。TCD、CTA检查敏感度、特异性及符合率分别为87.1%、75%、80.4%和95.5%、80%、92.6%。结论TCD、CTA是诊断颈动脉狭窄的有效手段,尤其是CTA。

Objective To observe the clinical manifestation and the carotid artery stenosis of intercranial artery transient isehemic attack （TIA）, and discuss the value of transcranial Doppler ultrasound （TCD） and computed tomographic angiography （CTA） in diagnosis of carotid artery stenosis in intercranial artery TIA. Methods DSA was performed in 56 patients with intercranial artery TIA and the clinical and distribution of carotid artery stenosis were analyzed,while TCD was performed in 46 patients and CTA was performed in 54 patients with TIA, then sensitivity, specifity and total consistent rate of TCD and CTA were calculated with Kappa test. Results 7.1% patients have atypical manifestations. Cranial artery stenosis was existed in 76.8% patients. The stenosis artery was vertebral-basiler aretery in 7.1% patients. Moderate-serious stenosis exists in 86.1% cranial artery stenosis. The frequency of stenosis of intracranial artery was higher than that of extracranial artery. According to NASCET crieria for DSA, the sensitivity, specificity, total consistent rate of TCD were 87.1% ,75.0% and 80.4% , respectively （ Kappa = 0.455 ）. While of those CTA were 95.5% , 80% , and 92.6% , respectively （ Kappa = 0. 475 ）. Conclusions TCD and especially CTA is useful for diagnosis of cranial artery stenosis. They show good consistency to DSA, but can not displace DSA in some cases.