经颅多普勒在烟雾病脑-硬膜-动脉融通术疗效评价中的应用

Application of transcranial Doppler in the efficacy evaluation of encephalo-duro-arterio-synangiosis for moyamoya disease

目的：探讨经颅多普勒超声（transcranial Doppler, TCD）在烟雾病脑-硬膜-动脉融通术（encephalo-duro-arterio-synangiosis, EDAS）疗效评价中的应用价值。方法接受 EDAS 治疗的烟雾病患者分别在术前和术后6个月进行数字减影血管造影（digital subtraction angiography, DSA）和 TCD检查,分别测量颞浅动脉手术前后的搏动指数（pulsatility index, PI）、阻力指数（resistance index, RI）和平均血流速度（mean flow velocity, MFV）,评价 TCD 参数变化率与 DSA 疗效分级的相关性,采用受试者工作特征（receiver operator characteristic, ROC）曲线计算 TCD 参数预测手术疗效的最佳截断值。结果共纳入46例烟雾病患者,40例为双侧半球受累,6例为单侧受累,共86侧大脑半球接受EDAS。根据 DSA 复查结果,疗效分级：0级18侧,1级37侧,2级18侧,3级13侧。当 DSA 分级为0级时,手术前后的 PI、RI 和 MFV 均无统计学差异,而其他各级 TCD 参数术后改变均具有统计学意义（P 均〈0．001）。术后6个月时,PI、RI 和 MFV 的变化率分别为-30．83%±21．71%、-19．64%±14．45%和96．08%±100．76%,与 DSA 疗效分级结果具有良好的相关性,其 Spearman 相关系数分别为-0．879、-0．891和0．715（P 均〈0．001）。 ROC 曲线分析显示,TCD 参数变化率预测手术疗效良好的最佳截断值分别为：PI 下降率=36%（曲线下面积=0．966；敏感性=0．968,特异性=0．891；P 〈0．001）、RI 下降率=27%（曲线下面积=0．973；敏感性=0．903,特异性=0．946；P 〈0．001）和 MFV上升率=111%（曲线下面积=0．879；敏感性=0．742,特异性=0．927；P 〈0．001）。结论 TCD 能检测 EDAS 术后颞浅动脉的血流参数变化,在术后长期疗效评价中具有较高的应用价值。

Objective To investigated the application value in the efficacy evaluation of transcranial Doppler （TCD） in encephalo-duro-arterio-synangiosis （EDAS） for moyamoya disease. Methods The patients with moyamoya disease treated with EDAS conducted digital subtraction angiography （DSA） and TCD examinations before procedure and at 6 months after procedure respectively. The pulsatility index （PI）, resistance index （RI） and mean flow velocity （MFV） before and after the superficial temporal artery surgery were measured respectively. The correlation between the TCD parameter variation rate and DSA efficacy grading was evaluated. Using the receiver operator characteristic （ROC） curve to calculate the optimal cut-off value of the TCD parameters for predicting the operation efficacy. Results A total of 46 patients with moyamoya disease were enroled, 40 patients were bilateral hemisphere involvement and 6 were unilateral involvement. A total of 86 hemispheres were treated with EDAS. According to the results of DSA reexaminations, the grades of efficacy were as folows： grade 0, 18 sides, grade 1, 37 sides, grade 2, 18 sides, and grade 3, 13 sides. When the DSA grade was 0, there were no significant differences in PI, RI and MFV before and after procedure, and there were significant differences in the postoperative change of other TCD parameters at al levels （al P 〈 0. 001）. At 6 months after procedure, the change rates of PI, RI and MFV were - 30. 83% ± 21. 71% , - 19. 64% ± 14. 45% and 96. 08% ± 100. 76% , respectively, and they had good correlation with the results of DSA efficacy grading. Their Spearman correlation coefficients were- 0. 879, - 0. 891 and 0. 715, respectively （al P 〈 0. 001）. ROC curve analysis showed that the best cutoff values of the TCD parameter change rates for predicting good operative effect were as folows： PI decrease rate, 36% （area under the curve, 0. 966; sensitivity, 0. 968, specificity, 0. 891; P 〈 0. 001）, RI decrease rate, 27% （area under the curve, 0. 973; sensitivity, 0. 903, specificity, 0. 946; P 〈 0. 001）, and MFV increase rate, 111% （area under the curve, 0. 879; sensitivity, 0. 742, specificity, 0. 927; P 〈 0. 001）. Conclusions TCD can detect hemodynamic parameter changes of superficial temporal arteries after EDAS. It has higher application value in the long-term postoperative efficacy evaluation.