三维能量多普勒成像诊断老年人颈内动脉狭窄的应用价值

The application value of three-dimensional power Doppler imaging in diagnosis of the internal carotid artery stenosis in the elderly

目的评定三维能量多普勒成像(3D-PDI)诊断老年人颈内动脉狭窄的应用价值。方法选择我院69例老年高血压、冠状动脉粥样硬化性心脏病、糖尿病、高脂血症患者,分别采用彩色多普勒血流成像(CDFI)、自由臂模式3D-PDI测量患者颈内动脉,并于检查后2周内进行数字减影血管造影(DSA)检查。以DSA为颈内动脉狭窄诊断的金标准,对3D-PDI诊断颈内动脉狭窄的敏感度、特异度、准确性、阳性预测值、阴性预测值等进行计算和评估。结果 3D-PDI可直观显示狭窄区的立体形状,包括斑块表面特性﹑狭窄部位﹑血管腔大小及血流空间走行等。69例患者85条狭窄颈内动脉,3D-PDI和CDFI测得的内径狭窄率分别为(49.2±0.7)%和(52.3±0.3)%,差异无统计学意义(t=3.26,P>0.05);测得的面积狭窄率分别为(53.2±0.7)%和(59.3±0.4)%,但差异有统计学意义(t=6.34,P<0.01)。3D-PDI诊断颈内动脉轻度狭窄的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为88.9%、100.0%、96.5%、100.0%和95.1%,诊断颈内动脉中度狭窄的分别为100.0%、96.6%、97.7%、93.1%和100.0%,诊断颈内动脉重度狭窄的分别为100.0%、98.1%、90.8%、96.9%和100.0%。CDFI诊断颈内动脉轻度狭窄的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为100.0%、63.8%、75.3%、56.3%和100.0%,诊断颈内动脉中度狭窄的分别为70.4%、100.0%、90.6%、100.0%和90.6%,诊断颈内动脉重度狭窄的分别为58.1%、100.0%、84.7%、100.0%和80.6%。与CDFI相比,3D-PDI诊断颈内动脉中度和重度狭窄的敏感度较好,准确性较高,但特异度较差。结论 3D-PDI诊断老年人颈内动脉狭窄较CDFI具有更高的敏感度和准确性,对老年人颈内动脉狭窄的诊断具有潜在的应用价值。

Objective To evaluate the application value of three-dimensional power Doppler imaging（3D-PDI） in diagnosis of the internal carotid artery stenosis in the elderly.Methods A total of 69 elderly patients with history of hypertension,coronary atherosclerosis,diabetes mellitus or hyperlipidemia were included in the study.The stenosis of the internal carotid artery was evaluted by colour Doppler flow imaging（CDFI） and 3D-PDI in free-hand mode within two weeks before digital subtraction angiography（DSA）.With the DSA results as the golden standard,the sensitivity,specificity,accuracy,positive and negative predictive values in the diagnosis of internal carotid artery stenosis by 3D-PDI were calculated and analyzed.Results 3D-PDI could directly show the stereo image,surface character and exact position of plaque,volume of vessel lumen,and spatial distribution of blood flow.Sixty-nine patients had 85 stenoses in the internal carotid arteries.No significant difference was found in diameter stenosis rate between 3D-PDI and CDFI[（49.2±0.7）% vs（52.3 ±0.3）%,t=3.26,P0.05].But there was a significant difference in area stenosis rate between 3D-PDI and CDFI[（53.2±0.7）% vs（59.3±0.4）%,t=6.24,P0.01].The sensitivity,specificity,accuracy,positive and negative predictive values in the diagnosis of internal carotid arteries stenosis by 3D-PDI were 88.9%,100.0%,96.5%,100.0% and 95.1% in patients with mild stenosis;100.0%,96.6%,97.7%,93.1% and 100.0% in patients with moderate stenosis;100.0%,98.1%,90.8%,96.9% and 100.0% in patients with severe stenosis.And the corresponding results of CDFI were 100.0%,63.8%,75.3%,56.3% and 100.0% in patients with mild stenosis;70.4%,100.0%,90.6%,100.0% and 90.6% in patients with moderate stenosis;58.1%,100.0%,84.7%,100.0% and 80.6% in patients with severe stenosis.In contrast,for moderate to severe stenosis of internal carotid arteries,3D-PDI had higher diagnotic sensitivity and accuracy than CDFI.However,the specificity was better in CDFI.Conclusions In diagnosis of internal caotid artery stenosis,3D-PDI has higher accuracy and sensitivity than CDFI.Therefore,3D-PDI has an application value in this field.