血管超声对椎动脉闭塞的血流动力学评价

Hemodynamic testing of vertebral artery occlusion assessed by vascular ultrasound

目的探讨彩色多普勒血流成像（ colour Doppler flow imaging, CDFI） 与经颅多普勒超声（transcranial Doppler，TCD）联合评价椎动脉闭塞性病变的血流动力学变化及其临床价值。方法选择2005年1月-2009年1月经CDFI和ICD联合检测并经数字减影血管造影（digital subtraction angiography,DSA）证实的椎动脉闭塞患者101例，以DSA结果为金标准，比较分析不同类型椎动脉闭塞侧与健侧椎动脉颅内、外段收缩期峰值血流速度（peak systolic velocity,PSV）、舒张末期血流速度（end diastolic velocity,EDV）、阻力指数（resistive index，RI）、搏动指数（pulsatility index,PI）、频谱形态和血流动力学差异。结果椎动脉全程闭塞患者，CDH和TCD均未探及血流信号；颅内段闭塞患者，CDFI在颅外段可探及微弱血流信号；节段性闭塞患者，颅外或颅内段椎动脉可探及侧支循环建立后的血流信号。椎动脉颅内段闭塞患者，颅外段患侧PSV较健侧显著降低[（27．39±12．44）cm／s对（62．61±13．22）cm／s，P=0．000）；RI显著高于健侧（0．99±0．21对0．62±0．07，P=0．000）。椎动脉节段性闭塞且有侧支循环建立时，闭塞侧颅内段椎动脉PSV、EDV和PI均较健侧显著降低，PSV分别为（37．81±12，28）cm／s和（73，17±30．99）cm／s（P=0．000），EDV分别为（17．58±7．10）cm／s和（29．31±12．94）cm／s（P=0．000），P1分别为（0．84±0．22）和（1．01±0．18）（P：0．000）。对照DSA显示椎动脉闭塞的部位不同，CDFI与TCD检测的血流频谱形态存在显著差异。结论PSV、EDV、RI和PI均是准确评价椎动脉闭塞的血流动力学参数，CDFI与TCD相结合，对于不同类型椎动脉闭塞的血流动力学变化和临床综合评估具有重要价值。

Objective To investigate the combination of color Doppler flow imaging （CDFI） and transcranial Doppler （TCD） in the assessment of the hemodynamic changes of vertebral artery occlusion disease and their clinical value. Methods A total of 101 patients with vertebral artery occlusion detected by the combination of CDFI and TCD and confirmed by DSA were enrolled from January 2005 to January 2009. Taking the result of digital subtraction angiography （DSA） as a golden standard, The differences between the different types of the side of vertebral artery occlusion and contralateral vertebral artery on the extra- and intracranial segments were compared and analyzed in peak systolic velocity （PSV）, end diastolic velocity （EDV）, resistive indices （RI）, pulsatility index （PI）, spectrum morphology, and hemodynamics. Results No blood flow signals were detected by CDFI and TCD in patients of complete occlusion of the vertebral artery; the weak blood flow signals were detected by CDFI in patients of the occlusion in the intracranial segment of the vertebral artery. The blood flow signals after the establishment of collateral circulation in patients of the segmental occlusion were detected in the extracranial segment or intracranial segment of the vertebral artery. The PSV on the occluded sides of the extracranial segments were decreased more significantly than that on the unoccluded sides （27.39 ± 12.44 cm/s vs. 62.61 ± 13.22 cm/s, P = 0. 000）; RI was significantly higher than the unoccluded sides （0.99 ± 0.21 vs. 0.62 ± 0.07, P = 0. 000）. When a vertebral artery had the segmental occlusion and the collateral circulation was established, the PSV, EDV, and PI of the intracranial segment of the vertebral artery on the occluded sides were decreased more significantly than those on the unoccluded sides, PSV were 37.81 ± 12.28 crn/s and 73.17 ±30.99 crn/s, respectively （P =0.000）, EDV were 17.58 ± 7.10 crn/s and 29.31 ± 12.94 cm/s, respectively （P = 0. 000）, PI were 0.84 ± 0.22 and 1.01 ±0.18, respectively （P =0. 000）. The compared DSA showed that the sites of vertebral artery occlusion were different. There was significant difference in the Doppler flow velocity spectrum between the CDFI and TCD. Conclusions PSV, EDV, RI, and PI are the hemodynamic parameters of accurately assessing vertebral artery occlusion, and the combination of CDFI and TCD has significant value for the hemodynamic changes of different types of vertebral artery occlusion and the clinical comprehensive assessment.