经颅彩色多普勒超声联合经颅超声造影诊断椎-基底动脉狭窄性中枢性眩晕的临床价值

The clinical valve of transcranial color-coded sonography and contrast-enhanced transcranial color-coded sonography in diagnosing vertebral-basilar artery stenosis central vertigo

目的探讨经颅彩色多普勒超声(TCCS)与经颅超声造影(CE-TCCS)联合应用评价椎-基底动脉(VBA)狭窄性中枢性眩晕患者血流动力学改变的临床价值。方法选取诊断为中枢性眩晕的患者35例为研究对象,所有患者均进行TCCS、CE-TCCS检查,并于一周内进行数字减影血管造影检查证实。分别计算两种检查方法的敏感度及特异度,并比较血管狭窄程度<50%与>50%的流速差异。结果 35例患者共105支血管,DSA显示>50%狭窄的血管共40支,闭塞血管12支;TCCS诊断椎-基底动脉>50%狭窄的敏感度为70.0%,特异度为71.7%(P<0.01),诊断闭塞的敏感度为66.7%,特异度为73.6%(P<0.01);CE-TCCS诊断椎-基底动脉>50%狭窄的敏感度为92.5%,特异度为90.6%(P<0.01),诊断闭塞的敏感度为91.7%,特异度为94.3%(P<0.01);>50%狭窄组血管的PSV、EDV及MFV均明显高于<50%狭窄组(P<0.01),而两组间PI值无明显差异(P=0.368)。结论 TCCS联合CE-TCCS检查可提高椎-基底动脉狭窄闭塞病变的诊断准确率,可应用于中枢性眩晕患者的常规筛查。

Objective To investigate the clinical value of transcranial color-coded sonography （TCCS） and contrastenhanced transcranial color-coded sonography （CE-TCCS） in diagnosing the hemodynamics changes of patients with vertebral-basilar artery stenosis central vertigo. Methods Thirty-five cases of patients with central vestibular vertigo were selected as the study objects. All the patients were taken with TCCS and CE-TCCS examination, and accepted digital subtraction angiography examination within one week. The sensitivity and specificity of two methods were calculated, and the difference of flow rate between 〈50% and 〉50% was compared. Results There were 35 patients with 105 vessels, the DSA showed that the 〉50% stenosis were 40 branches and the vaacular occlusion were 12 branches. The sensitivity and specificity of TCCS in diagnosing vertebral - basilar artery stenosis 〉50% were 70.0% and 71.7% （P〈0.01）; the sensitivity and specificity of TCCS in diagnosing blocking were 66.7% and 73.6% （P〈0.01）. The sensitivity and specificity of CE-TCCS in diagnosing vertebral-basilar artery stenosis 〉50% were 92.5% and 90.6% （P〈0.01）; the sensitivity and specificity of CE-TCCS in diagnosing blocking were 91.7% and 94.3% （P〈0.01）. The peak systolic velocity, end diastolic velocity and mean flow rate of blood vessel in stenosis 〉50% group were significantly higher than those in stenosis 〈50% group （P〈0.01）, the pulsatility index had no significant difference between the two groups （P=0.368）. Conclusion TCCS and CE-TCCS joint inspection can enhance the accuracy rate of diagnosis in vertebral-basilar artery stenosis occlusion lesions, and can be used in routine screening for patients with central vestibular vertigo.