彩色多普勒超声在颈动脉病变诊治中的应用

Application of color doppler ultrasound in the diagonosis of carotid artery disease

目的彩色多普勒超声在颈动脉病变诊治中的应用。方法应用彩色多普勒超声筛选出颈动脉粥样硬化斑块狭窄甚至闭塞的患者。超声检查内容包括斑块的大小、回声以及稳定性,斑块造成狭窄时,计算狭窄率,同时记录血管内径及血流动力学指标。重度狭窄及闭塞患者要评估颅内侧支循环的建立情况,并与磁共振血管成像(MRA)和血管造影(DSA)对比分析。最后经过临床筛选54例患者共56条颈动脉接受内膜剥脱术(CEA)或颈动脉扩张成形加支架植入(CAS)手术治疗(包括1例无症状颈动脉狭窄患者)。结果超声对斑块回声及其稳定性评价优于其它影像学,狭窄程度判断与其它影像基本相符合;对颅内侧支循环的评估与DSA相同但优于MRA;术后颈内动脉内径及血流速度较术前有明显改善,内径〔(4.1±0.5)mm VS(1.4±0.5)mm,P<0.01〕;流速〔(74.2±13.1)cm/s VS(205±132.4)cm/s,P<0.01〕。结论彩色多普勒超声对颈动脉病变的部位、范围、动脉硬化斑块的稳定性以及狭窄的程度诊断率高,能够客观反映血流动力学改变,评估颅内侧支循环的建立情况,为是否需要手术治疗提供科学依据。同时为评价治疗效果以及术后随访和临床无症状的健康筛查提供有效便捷的手段。

Objective To investigate the application of color dopplor ultrasound in catotid artery disease.Methods By use of color doppler ultrasound,patients with atherosclerotic plaque and,even,occlusion of carotid artery were chosen in this work.The parameters,which were examined by sonography,included the plaque size,echogenicity,and stability.When the plaque resulted in stenosis,the stenosis degree was calculated,and diameter of vessels and index of haemodynamics were recorded.As for the patients with severe stricture and block,it was necessary for evaluating the establishment of intracal collateral circulation,and analyzing the situation in comparision to magnetic resonance angiography（MRA） and digital subtraction angiography（DSA）.Finally,56 carotid arteries of 54 patients were chosen to underwent carotid endarterectomy（CEA） or carotid angioplasty and stenting（CAS）,including a carotid artery stenosis patient without symptom.Results Sonography was superior to other imaging examinations in evaluating plaque echo and stability,and the judgement of stenosis degree was consistent with others.The Evaluation of intracal collateral circulation was the same as that by DSA,but,better than that by MRA.Carotid artery diameter had been signidicantly improved as compared with preoperative diameter（（4.1±0.5） mm VS（1.4±0.5） mm,P0.01）,and velocity（（74.2±13.1） cm/s VS（205±132.4） cm/s,P0.01）.Conclusion Color Doppler ultrasound has high value in diagnosing catorid artery disease in terms of site,extent,stability of arteriosclerosis plaque,and degree of stenosis.This approach can objectively reflect the change of haemodynamics and evaluate the establishment of intracal collateral circulation,thereby providing scientific evidence to determine the possibility of operation.Taken together,color Doppler ultrasound can represent a useful and convenient method to assess therapeutic efficacy,to follow up,and to screen asymptomatic patient.