经颅多普勒超声对单侧MCA重度狭窄或闭塞及侧支循环的诊断与研究

Research of TCD on Diagnosis and the Collateral Circulation in Patients with Severe Stenosis or Occlusion of the Unilateral Middle Cerebral Artery

目的探讨经颅多普勒超声(TCD)对单侧大脑中动脉(MCA)重度狭窄或闭塞的诊断价值以及颅内血流动力学的改变与相应软脑膜侧支(LMCs)开放的关系。方法将48例MCA重度狭窄或闭塞患者的TCD检查结果与DSA检查结果进行对比,计算TCD判断大脑前动脉(ACA)和大脑后动脉(PCA)的LMCs开放的特异性与敏感性(%)。结果TCD对MCA重度狭窄或闭塞的诊断与DSA检查的符合率为89.6%,Kappa值为0.79(P<0.01),呈高度一致性。以同侧ACA血流速度(iV_(ACA))>对侧MCA血流速度(cV_(MCA))为判断ACA的LMCs开放的标准,TCD的敏感性为90.5%,特异性为70.4%,Youden指数(YI)=0.61;以iV_(PCA)>cV_(MCA)为判断PCA的LMCs开放的标准,TCD的敏感性为45.5%,特异性为84.6%,YI=0.30。结论TCD对MCA重发狭窄或闭塞的诊断准确性较高;TCD能间接判断MCA病变后的LMCs开放情况。

Objective To explore and discuss the diagnostic value in severe stenosis or occlusion of the middle cerebral artery （MCA）. To explore the relationship between the parametric changes Of the cerebrovascular hemodynemics and opening of the leptomeningeal collateral channels （LMCs）. Methods Transcranial doppler （TCD） results and DSA results in 48 cases of severe stenosis or occlusion of MCA were compared. The specificity and sensitivity of the standards in LMCs opening of the anterior cerebral artery （ACA） and the posterior cerebral artery（PCA） were judged with TCD according to DSA results. Results The coincidence rate of DSA with TCD in diagnosis of the severe stenosis or occlusion of MCA was 89.6%. The Kappa value was 0. 79（P〈0. 01）. The sensitivity and specificity of the standards in LMCs opening of ACA judged by iVAcA CVMcA with TCD were 90. 5% and 70.4%, respectively. Youden Index （YI）= 0. 61. The sensitivity and specificity in LMCs opening of PCA judged by iVpcA〉cVMcA with TCD were 45.5% and 84. 6%, respectively. YI=0.30. Conclusions The situation of opening of the collateral branches of MCA after disease can be judged indirectly with TCD.