双功能彩超与经颅多普勒超声对颈内动脉狭窄或闭塞的临床价值

Clinical value of combining color duplex flow imaging and transcranial Doppler ultrasound in diagnosing severe stenosis or occlusion of internal carotid artery

目的探讨双功能彩超(CDFI)与经颅多普勒超声(TCD)对颈内动脉(ICA)重度狭窄或闭塞诊断的准确率、敏感性和特异性。方法选择我院2008年5月～2011年10月收治的300例缺血性脑血管病患者行CDFI和TCD常规检测,其中42例患者(84支动脉)确定为单侧或双侧ICA狭窄或闭塞,经脑血管造影(DSA)检测证实。详细检测记录ICA近段(分叉水平上方1.0～1.5 cm)、ICA远段收缩期峰值流速(PSV:PSVst、PSVdis、PSVpro)、狭窄段的平均流速(MFVst),与狭窄远段的流速比值(PSVst/PSVdis、PSVst/PSVpro)。将CDFI、TCD及二者综合诊断结果分别与脑血管造影(DSA)对比分析。结果 DSA检测结果中本组84支颈内动脉27支正常(32.14%),轻度狭窄14支(16.67%),中重度狭窄20支(23.81%),闭塞23支(27.38%);轻度至闭塞患者中PSVst、MFVst随着狭窄程度的加重逐渐增加,且差异有统计学意义(P<0.05)。本研究中42例患者84支颈血管CDFI与DSA完全符合81支,假阳性1支,假阴性2支,准确率为96.4%,敏感性为97.6%,特异性为96.0%。TCD与DSA完全符合82支,假阳性1支,假阴性1支,准确率为97.6%,敏感性为98.4%,特异性为95.0%。二者综合结果确定狭窄35支,闭塞23支,正常28支,与DSA符合率为98.8%(83/84)。结论 CDFI和TCD的联合应用提高了对重度ICA狭窄或闭塞的诊断准确性,为临床采用不同的治疗手段提供了一种可靠的无创性综合检测分析方法。

Objective To explore the sensitivity, specificity and overall accuracy of color duplex flow imaging （CDFI） and transeranial Doppler （TCD） in diagnosing severe stenosis or occlusion of internal carotid artery （ICA）. Methods 300 cases of the patients with isehemic cerebrovascular disease were selected in our hospital from May 2008 to October 2011, and they were all examined by CDFI and TCD traditionally. 42 cases （84 arteries） with unilateral or bilateral stenosis or occlusion of ICA were detected and confirmed by digital subtraction angiography （DSA）. ICA proximal segment （bifurcation level above 1.0 to 1.5 cm）, the ICA distal peak systolic velocity （PSV： PSVst, PSVdis, PSVpro）, the average velocity of the narrow segment （MFVst）, the flow rate ratio and narrow distal （PSVst/PSVdis, PSVst/PSVpro） were detected and recorded exactly. The results of CDFI, TCD and combination of two methods with DSA were compared and analyzed. Results DSA detection results with all the 84 internal carotid artery and 27 arteries were normal （32.14%）, mild narrow was 14 arteries （16.67%）, moderate to severe stricture was 20 arteries （23.81%）, shut up was 23 arteries （27.38%）; among patients with mild to block PSVst, MFVst with narrow degree of increase gradually increasing, and the difference was significant （P 〈 0.05）. 42 patients with vascular CDFI and 84 neck DSA fully comply with 81 arteries, false positive was 1 artery, 2 arteries was false negative, accuracy was 96.4%, sensitity was 97.6%, specificity was 96.0%. With DSA full compliance with TCD 82 arteries, false positive was 1 artery, 1 artery was false negative, accuracy was 97.6%, sensitity was 98.4% and specificity was 95.0%. Both comprehensive results to determine narrow 35 arteries, shut up 23 arteries, normal 28 arteries, and in line with DSA was 98.8% （83/84）. Conclusion CDFI and TCD provide a higher accuracy in diagnosing severe carotid atherosclerosis diseases, and provide a reliable, noninvasive detection analysis method to different treatment methods in clinic.