TCD对ICA闭塞或重度狭窄患者侧支循环开放的诊断价值

Diagnostic value of TCD in opening of collateral circulation in patients with ICA occlusion or severe stenosis

目的研究经颅多普勒超声(TCD)对颈内动脉(ICA)闭塞或重度狭窄患者颅内侧支循环开放的诊断价值。方法选择医院诊治的颈内动脉闭塞或重度狭窄患者198例,根据临床表现、头颅CT和MRI检查的结果,将患者分为脑梗死(CI)组、短暂性脑缺血发作(TIA)组及无症状(Asy)组。采用TCD检测3组颅内侧支循环的开放情况,比较3组的侧支开放率,计算TCD诊断侧支循环的特异性和敏感性。结果本组198例中,TCD检出颈内-外动脉侧支循环开放79例(39.90%),前交通动脉开放98例(49.49%),后交通动脉开放85例(42.93%)。与数字减影血管造影(DSA)检测结果相比,TCD共有253条开放的侧支循环与DSA结果相符,假阳性9条,假阴性2条,TCD诊断侧支循环开放的特异性为90.43%,敏感性为99.21%;TCD检测结果中,TIA组的颈内-外动脉侧支开放率明显高于CI组和Asy组(P<0.05);Asy组的前交通动脉开放率和后交通动脉开放率明显高于CI组和TIA组(P<0.05)。结论 TCD对颈内动脉闭塞或重度狭窄患者颅内侧支循环开放具有较高的诊断敏感性和特异性,对临床具有较高的指导价值。

Objective To study the diagnostic value of transcranial Doppler sonography(TCD) in the opening of intracranial collateral circulation in patients with internal carotid artery(ICA) occlusion or severe stenosis. Methods A total of 198 patients with ICAO or severe stenosis admitted to our hospital were selected and divided into CI group, TIA group and Asy group according to the clinical manifestation and results of head CT and MRI examination. The opening of intracranial collateral circulation in the three groups was detected with TCD to compare the collateral opening efficiency among the three groups and calculate the specificity and sensitivity of TCD in diagnosis of collateral circulation. Results Among the 198 patients, TCD detected 79 cases(39.90%) of internal and external carotid artery collateral circulation opening, 98 cases(49.49%) of anterior communicating artery opening and 85 cases(42.93%) of posterior communicating artery opening. Compared with the results of DSA, TCD had 253 open collateral circulations in compliance with the results of DSA. There were 9 cases of false positive and 2 cases of false negative. The specificity of TCD in the diagnosis of collateral circulation opening was 90.43%, and the sensitivity was 99.21%; in the results of TCD detection, the internal and external carotid artery collateral circulation opening rate in TIA group was significantly higher than that in CI group and Asy group(P < 0.05); the anterior and posterior communicating artery opening rate in Asy group was much higher than that in CI group and TIA group(P < 0.05). Conclusion TCD has high specificity and sensitivity in the diagnosis of the opening of intracranial collateral circulation in patients with internal carotid artery(ICA) occlusion or severe stenosis and has high guiding value for clinical practice.