经颅彩色多普勒超声对颅内段椎动脉狭窄血流动力学的评价标准

Evaluation criteria of transcranial color-coded sonography for the hemodynamics of intracranial segment vertebral artery stenosis

目的探讨经颅彩色多普勒超声（TCCS）诊断颅内段椎动脉狭窄的血流动力学参数标准。方法回顾性纳入622例门诊或住院可疑后循环缺血患者，从中选取经TCCS、彩色多普勒血流显像（CDFI）筛查和DSA检查的患者共216例，其中颅内椎动脉正常者33例（15．3％），狭窄率〈50％者45例（20．8％），狭窄率为50％～69％者44例（20．4％），狭窄率为70％-99％者94例（43．5％）。通过检测颅内段椎动脉、椎间隙段收缩期峰值流速（PSV1、PSV2）和舒张期末流速（EDV1、EDV2），分别计算颅内段平均流速（MV）、颅内段与椎间隙段收缩期峰值流速、舒张期末流速的比值SPRP（PSV，／PSV：）、SPRE（EDV，／EDV：）。以DSA检查结果为标准，计算受试者工作特征（ROC）曲线下面积，获得最佳截断点。结果TCCS诊断颅内段椎动脉狭窄血流动力学参数最佳截断点分别为：狭窄率〈50％的参数标准为110cm／s≤PSV1≤145cm／s，65cm／s≤MV≤85cm／s；狭窄率为50％～69％的参数标准为145cm／s≤PSV1≤190cm／s，85cm／s≤MV≤115cm／s；狭窄率为70％～99％的参数标准为PSV，≥190cm／s，MV≥115cm／s。结论TCCS可有效评价颅内段椎动脉狭窄的血流动力学变化，为颅内段椎动脉狭窄的超声评判标准提供参考。

Objective To investigate the criteria of hemodynamic parameters for diagnosis of intracranial segment vertebral artery stenosis with transcranial color-coded sonography （TCCS）. Methods A total of 622 outpatients or inpatients with suspected posterior circulation ischemia were enrolled retrospectively, from which 216 patients were selected with TCCS, color Doppler flow imaging （CDFI） screen, and digital subtraction angiography （DSA） examination, including 33 patients （ 15.3 % ） had normal intracranial vertebral arteries, the stenosis rates 〈 50% were 45 cases （20.8%） , 50% -69% were 44 cases （20.4%）, and 70%-99% were 94 cases （43.5%）. The mean velocity （MV） of intracranial segment, the ratios SPRv （PSV1/PSV2 ）, SPRE （EDVI/EDV2 ） of the systolic and end diastolic flow velocity between the intracranial segment and the intervertebral space segment were calculated respectively by detecting the intracranial segment of vertebral artery, the intervertebral space segment peak systolic velocity （ PSV1 , PSV2 ） and end diastolic velocity （ EDV2, EDV1 ）. The DSA findings were used as the criteria,the area under the receiver operating characteristic （ROC） curve was calculated and the optimal cut-off points were obtained. Results The optimal cut-off points of TCCS diagnosis of intracranial vertebral artery stenosis were as follows：the parameter standards of stenosis rate 〈 50% were 110 cm/s≤ PSV1 ≤ 145 cm/s and 65 cm/s≤ MV ≤85 cm/s, the parameter standards of stenosis rate 50% -69% were 145 cm/s≤ PSV1 ≤ 190 cm/s and 85 cm/s ≤ MV ≤ 115 cm/s, and the parameter standards of stenosis rate 70%-99% were PSVI 〉/190 cm/s and MV/〉 115 cm/s. Conclusion TCCS may effectively evaluate the hemodynamie changes of intraeranial vertebral artery stenosis and provide reference for the ultrasound evaluation criteria of intraeranial vertebral artery stenosis.