经颅多普勒超声对急性缺血性脑卒中患者颅内外血管狭窄诊断准确性的研究

Study on the Diagnostic Aaccuracy of TCD for Intracranial and Extracranial Arterial Stenosis in Patients with Acute Ischaemic Stroke

目的通过与计算机血管成像(CTA)对比,探讨经颅多普勒超声(TCD)作为一种颅内外血管狭窄的筛查工具,对急性缺血性脑卒中患者颅内外血管狭窄的诊断准确性。方法选择2013年5月至2014年5月急性缺血性脑卒中患者224例,均在发病后7 d内入院,临床症状及影像学符合急性缺血性脑卒中的临床诊断。患者入院后行床边TCD筛查及高分辨率CTA检查。结果 TCD对不同类型颅内外血管狭窄诊断的准确性存在差异。TCD对颈内动脉系统血管狭窄的诊断准确性最高,敏感性96.19%,特异性98.60%,对椎—基底动脉系统血管狭窄的敏感性71.11%,特异性94.31%,且TCD能够显示某些CTA不能提供的补充信息,如实时脱落的微栓子信号、侧支循环开放情况以及盗血现象。结论与CTA比较,TCD在评估急性缺血性脑卒中患者颅内外动脉狭窄方面,尤其是对于颈内动脉系统,具有较高的准确性,同时TCD能提供CTA所不具备的实时血流动力学信息。

Objective To evaluate the diagnostic accuracy of transcranial dopplei（TCD） as an additional screening tool for intracranial arterial steno- occlusive disease in patients with acute ischaemic stroke （AIS） by comparing with the computed tomography angiography （ CTA ）. Methods Two hundred and twenty-four consecutive patients who were hospitalized within 7 days of the onset of symptoms and fulfilled the criteria for the chnical di- agnosis of AIS between May 20I 3 and May 2014 were enrolled for the study. Among the 224 patients, there were I 18 males and 106 females with an average age of 61.2＋-12.6 years. High-resolution brain CTA was performed after completion of TCD. Results There was slight distinction of the diag- nostic accuracy of TCD for different arteries. TCD demonstrated the most accurate diagnosis for carotid artery vascular system, with a sensitivity of 96.19% and specificity of 98.60%. For the vertebrobasilar vascular system, TCD diagnosis showed a sensitivity of 71.11% and specificity of 94.31%. TCD findings were complementary to the CTA results （real-time embolization, collateral flow patterns and steal phenomenon ）. Conclusion TCD shows a high diagnostic accuracy comparing to CTA in evaluating intracrartial and extracranial arterial stenosis in patients with AIS, especially for the carotid artery vascular system analysis within a short time interval. TCD can also provide additional real-time dynamic findings complementary to the information provided by CTA.