初步探讨彩色多普勒血流成像三种参数标准评价颈内动脉粥样硬化性狭窄的诊断价值

Initial exploration of the diagnostic value of three kinds of standards for parameters of color Doppler flowing imaging in assessing the degree of inter carotid artery atherosclerotic stenoses

目的评价彩色多普勒血流成像(CDFI)技术三种参数标准对颈内动脉粥样硬化性狭窄(ICAS)的诊断价值,为客观评估现存的ICAS超声参数标准的有效性提供理论依据。方法对60例症状性脑缺血患者120支颈内动脉行彩色多普勒超声及数字减影血管造影(DSA)检查,采用CDFI三种参数标准即2003年美国放射年会超声会议公布的参数标准(标准一)、2006年澳大利亚超声医学会推荐的参数标准(标准二)、2006年首都医科大学宣武医院提出的参数标准(标准三)分别评估每支颈内动脉的狭窄程度。结果 CDFI三种参数标准评估ICAS的受试者特征(ROC)曲线及一致性检验结果显示三种参数标准均有效(AUC>0.90),三组评估结果与DSA结果均一致(P<0.001),其中标准二评估结果与DSA一致性最高(Kappa值=0.76),对中、重度ICAS的诊断敏感性(64.00%、81.25%)和准确性(89.17%、96.67%)高于另两种标准。结论 CDFI三种参数标准均可有效地评估ICAS程度,标准二诊断中、重度ICAS的有效性优于另两种标准。

Objective To evaluate the diagnostic values of three kinds of standards for parameters of color Doppler flow imaging （CDFI） in assessing the degree of inter carotid artery atherosclerotic stenoses （ICAS）, and to provide objective evidences for estimating the effectiveness of the existent standards. Methods Sixty patients with symptoms of cerebral ischaemia （ 120 arteries）were examined with color Doppler ultrasound （CDUS） and DSA. The stenosis degree of each inter carotid artery （ICA） was respectively assessed by three kinds of standards, including the standard proposed by the Society of Radiologists in Ultrasound Consensus in 2003, the standard recommended by Australian Society for Ultrasound in Medicine in 2006, and the standard preferred by Xuanwu Hospital of Capital Medical University in 2006. Results The results of receiver-operator characteristic （ROC） and coincidence test of three kinds of standards for assessing ICAS demonstrated that three standards were effective （AUC〉0.90）, and all assessment results of these three groups had similarity to DSA （P〈0.001）.The results of the second standard had the highest overall similarity to DSA （K=0.76）. The sensitivity （64.00%, 81.25% ） and accuracy （89.17%, 96.67% ） for diagnosing 50%~69%and 70%-99% stenoses were both higher than other two standards. Conclusion The three kinds of standards are effective in assessing the stenosis degree of ICA. The second standard may be superior to the other two standards in diagnosis of moderate and critical stenoses（50%-69% and 70%-99%）. But it＇s necessary to make further study by expanding samples.