血管超声对颈部动脉夹层的临床诊断价值

Diagnostic value of vascular ultrasonography in cervical carotid artery dissection

目的:探讨血管超声对颈部动脉夹层(cervical artery dissection,CAD)的临床诊断价值。方法:选择2016年1月至2017年3月于江苏省苏北人民医院就诊的32例怀疑CAD患者的超声影像学资料进行回顾性分析,并以高分辨率MRI和(或)DSA为诊断标准,计算血管超声诊断CAD的敏感度、特异度及准确度。结果:32例患者中确诊动脉夹层19例,共23处,包括18处颈内动脉夹层、5处椎动脉夹层。血管超声直接征象表现为壁内血肿14处、双腔5处、瘤样扩张3处、瓣膜漂浮1处;间接征象包括夹层位于非粥样硬化好发部位,夹层近段或远段阻力指数改变,夹层与对侧正常血流速度的差异超过50%。以MRI和(或)DSA检查结果为标准,血管超声诊断CAD的敏感度为91.3%、特异度为89.5%、准确度为90.5%,ROC曲线下面积为0.904。将血管超声与MRI行一致性检验,Kappa值为0.808。结论:血管超声对CAD有较好的诊断价值,且具有微创优势,值得临床推广。

Objective：To investigate the imaging features and diagnostic value of vascular ultrasonography in cervical artery dissection （CAD）. Methods：32 patients suspected of CAD were selected from Janaury 2016 to March 2017 in Subei People’s Hospital of Jiangsu Province. All patients detected by ultrasonography, high-resolution magnetic resonance imaging （HR-MRI） and （or） digital subtraction angiography. According to the results of HR-MRI and （or） DSA, the sensitivity, specificity and accuracy of vascular ultrasonography in CAD patients were determined. Results：19 patients with a total of 23 dissections （18 internal carotid arteries and 5 vertebral arteries） were confirmed. The direct ultrasound signs of CAD consisted of intramural hematoma（14）, double lumens（5）, aneurysmal dilatation（3）, and intimal flap（1）.Indirect ultrasound signs of CAD included stenosis/occlusion in a segment usually not affected by atherosclerosis, increased or decreased pulsatility upstream or downstream to the suspected arterial lesion, 〉50% difference in the blood flow velocity compared to the same segment of the artery on the unaffected side. Compared with HR-MRI and （or） DSA, the sensitivity of ultrasonography for CAD was 91.3%, the specificity was 89.5%, the accuracy was 90.5%. The ROC analysis showed the area under the curve was 0.904. There was a high level of agreement between ultrasonography and HR MRI （Kappa=0.808）. Conclusions：Vascular ultrasonography can diagnose CAD effectively. It has the advantage of minimally invasive, and is useful to clinical practice.