血管超声评估颈动脉夹层的前瞻性研究

The prospective study of vascular ultrasonography in assessing carotid artery dissection

目的前瞻性研究颈部血管超声(CDU)评估颈动脉夹层(CAD)的可行性及可靠性。方法对35例(70支颈动脉)缺血性脑卒中患者行CDU、颈部高分辨率磁共振成像(HRMRI)和(或)数字减影血管造影(DSA)检查。CDU设定CAD为4种类型:(1)壁内血肿型:低回声且边缘规则的均质物质充填导致管腔呈"火焰样"狭窄或闭塞;(2)双腔型:真腔与假腔内见双向血流信号;(3)瘤样扩张型:局部管径瘤样扩张导致管腔狭窄或闭塞;(4)瓣膜漂浮型:管腔内见漂浮的撕裂内膜。CDU结果分别与HRMRI及DSA结果进行一致性检验,并计算CDU诊断CAD的敏感性、特异性、阳性预测值及阴性预测值。结果 CDU评估CAD 33支,HRMRI和(或)DSA证实CAD 35支。以HRMRI和(或)DSA检查为标准,CDU诊断CAD敏感性91%,特异性97%,阳性预测值97%,阴性预测值92%。Kappa检验:CDU与HRMRI一致性极佳(Kappa=0.900,P=0.000),CDU与DSA一致性良好(Kappa=0.509,P=0.007)。结论颈部血管超声可准确、无创、实时动态评估颈动脉夹层,对早期发现并实施个体化治疗具有重要意义。

Objective To prospectively study the feasibility and reliability of carotid Doppler ultrasonography（ CDU） in evaluating carotid artery dissection（ CAD）. Methods 35 cases patients（ 70 carotid arteries） with ischemic stroke or transient ischemic attack were detected by CDU,Cervicocerebral High-resolution magnetic resonance imaging（ HRMRI） ± digital subtraction angiography（ DSA）. Four types of CAD were setted by CDU：（ 1） intramural hematoma：homogeneous materials with low echogenicity and margin regularity leading to a flame-like stenosis or occlusion of this artery;（ 2） double lumen： true and false lumens with red and blue blood flow signals.（ 3） aneurysmal dilatation： local artery diameter with aneurysmal dilatation leading to a stenosis or occlusion of this artery.（ 4） intimal flap： the tearing of intima detected in the lumen. The consistency of the results of CDU,HRMRI and DSA were checked. Make the results of HRMRI ±DSA as the standard to calculate the sensitivity,specificity,positive predictive value（ PPV） and negative predictive value（ NPV） of CDU for the diagnosis of CAD. Results CDU showed 33 carotid arteries with CAD,HRMRI ± DSA diagnosed35 carotid arteries with CAD. Thus,sensitivity,specificity,PPV,NPV for CDU diagnosis of CAD was 91%,97%,97%,and92%,respectively. The results of Kappa value： There was a high level of agreement between CDU and HRMRI（ Kappa =0. 900,P = 0. 000）,there was a moderate level of agreement between CDU and HRMRI（ Kappa = 0. 509,P = 0. 007）.Conclusion CDU can evaluate CAD properly with real-time dynamic images as a noninvasive methoed and have important implications for early detection and individual treatment.