彩色多普勒超声诊断缺血性脑血管病:与CTA、DSA对比分析

Color Doppler ultrasound in diagnosis of ischemic cerebral vascular disease:Compared with CTA or DSA

目的探讨彩色多普勒超声(CDU)诊断缺血性脑血管病(ICVD)的价值。方法回顾性分析107例ICVD患者(缺血组)及79例无ICVD患者(对照组)的TCCD和(或)TCD及颈动脉超声资料,观察颅外动脉及颅内动脉超声征象,并与CTA或DSA结果进行对照。采用Logistic回归模型评价CDU检测指标与ICVD的相关性。结果经CTA或DSA证实,缺血组颅内动脉狭窄22例(22/107,20.56%),颅外动脉狭窄77例(77/107,71.96%);对照组颅内动脉均无狭窄,颅外动脉狭窄34例(34/79,43.04%)。缺血组与对照组比较,颅外动脉的IMT、斑块数量及性质、管腔狭窄程度差异均有统计学意义(P均<0.05)。CDU诊断ICVD患者颅内动脉狭窄与CTA或DSA的一致性中等(Kappa=0.730),诊断颅外动脉狭窄的一致性良好(Kappa=0.883)。ICA狭窄(P=0.005)、软斑/溃疡斑(P=0.002)、VA狭窄(P=0.029)与ICVD的发生相关。结论 CDU诊断ICVD患者颈动脉狭窄与CTA或DSA具有较好的相关性,ICA狭窄、软斑/溃疡斑、椎动脉狭窄是ICVD的危险因素。

Objective To investigate the application value of color Doppler ultrasound （CDU） in diagnosis of ischemic cerebral vascular disease （ICVD）. Methods The findings of transcranial color Doppler （TCCD） and/or transcranial Doppler （TCD） of 107 patients with ICVD （ischemic group） and 79 patients without ICVD （control group）, were retro- spectively analyzed. Ultrasound features of intracranial and extracranial arteries were observed, and the results of ultra- sound were compared with these of CTA or DSA. Logistic multi-factor regression analysis was performed to analyze the correlation between CDU and ICVD. Results Confirmed by CTA/DSA, patients with intracranial artery stenosis appeared in 22 cases （22/107, 20. 56 %） in ischemic group. There was no patients with intracranial artery stenosis in control group. Patients with extracranial artery stenosis appeared in 77 cases （77/107, 71.96 %） in ischemic groups and 34 cases （34/79, 4：3.04%） in control groups. The consistency for the diagnosis of extracranial artery stenosis were better than that for the diagnosis of intracranial artery stenosis between CDU and CTA or DSA （Kappa 0. 883 vs 0. 730）. The IMT, plaque num- ber, size and property and the extent of stenosis of extracranial artery had statistic difference between ischemic and control groups （all P〈0.05）. Logistic regression indicated that internal carotid artery stenosis （P=0. 005）, soft/ulcer plaque （P =0. 002） and vertebral artery stenosis （P=0. 029） correlated with ICVD. Conclusion There was correlation between CDU and CTA/DSA in the diagnosis of carotid artery stenosis in patients with ICVD. Internal carotid artery stenosis, soft/ ulceration plaque and vertebral artery stenosis are risk factors for predicting the occurrence of ICVD.