超声造影在颅内椎-基底动脉狭窄诊断中的作用

Primary Application of Transcranial Contrast Enhanced Ultrasound in the Stenosis of Intracranial Vertebro-Basilar Artery

目的探讨经颅超声造影(contrast-enhanced transcranial color-coded sonography,CE-TCCS)诊断椎-基底动脉狭窄或闭塞的临床价值。方法对14例临床疑似椎-基底动脉狭窄或闭塞的患者分别行常规经颅彩色多普勒超声(transcranial color-coded sonography,TCCS)及CE-TCCS检查,分别比较这两种检查方法与数字减影血管造影(digital subtraction angiography,DSA)对椎-基底动脉狭窄的的符合程度。结果临床疑似椎-基底动脉狭窄的14例患者共42支动脉(28支椎动脉和14支基底动脉),CE-TCCS显像中诊断为狭窄或闭塞的有29支,其中28支均被DSA证实;有13支.CE-TCCS诊断为正常的血管,其中12支与DSA结果一致。相对的,TCCS显像中诊断为狭窄或闭塞的有21支,其中19支被DSA证实;有21支TCCS诊断为正常的血管中只有11支与DSA结果一致。以DSA为标准,CE-TCCS诊断椎-基底动脉狭窄与DSA的吻合系数Kappa=0.889,P<0.01;TCCS诊断椎-基底动脉狭窄与DSA的吻合系数Kappa=0.429,P<0.05。结论 CE-TCCS检查有助于提高椎-基底动脉狭窄的血流显示。在诊断椎-基底动脉狭窄方面,与TCCS相比,CE-TCCS与DSA结果显示出更好的一致性。

Objective To explore the clinical value of contrast-enhanced transcranial color-coded sonography（CE-TCCS） in diagnosing intracranial vertebro-basilar stenosis and occlusion. Methods Transcranial color-coded sonography（TCCS） was performed in 14 patients who were firstly diagnosed with stenosis and occlusion of vertebro-basilar artery（VBA） before and after injection of ultrasound contrast agent. These two methods were compared with digital subtraction angiography in the diagnosis of VBA stenosis and showed the degree of coincidence. Results A total of 14 patients ,who were suspected to have VBA stenosis including 42 arteries（28 vertebro arteries and 14 basilar arteries）. The CE-TCCS showed 29 arteries stenosis or occlusion and DSA showed 28 arteries stenosis or occlusion finally. The CE-TCCS showed 13 normal VBA and 12 of them were confirmed by DSA. The TCCS showed 21 arteries stenosis or occlusion and DSA showed 19 arteries stenosis or occlusion finally. The TCCS showed 21 normal VBA and only 11 of them were confirmed by DSA.The measure of agreement Kappa between TCCS and angiography was 0.429, P〈0.05. Meanwhile, the measure of agreement Kappa between CE-TCCS and angiography was 0.889（P〈0.01）. Conclusion Contrast-enhanced transcranial color-coded sonography greatly improved the signals of blood flow in the diagnosis of vertebrobasilar artery stenosis and showed higher consistency with the results of angiography compared to that of TCCS.