大脑中动脉中重度狭窄或闭塞性病变患者同侧颅外颈动脉血流动力学的分析

Analysis of the hemodynamics changes of ipsilateral extracranial carotid artery with middle cerebral artery stenosis or occlusion patients

目的:观察大脑中动脉中重度狭窄或闭塞的患者同侧颅外颈动脉的血流动力学,探讨颅外颈动脉血流动力学改变对预测大脑中动脉狭窄的价值,以提高检出率和准确性。方法:对经TCD检测、磁共振血管成像(MRA)证实存在单侧大脑中动脉中重度狭窄或闭塞的83例患者进行多普勒超声颅外颈动脉检查,分析其颅内外血流动力学参数的相关性。结果:大脑中动脉重度狭窄或闭塞患者其患侧颈总动脉(CCA)、颈内动脉颅外段(ICA)呈低流速高阻力血流信号改变。颈内动脉颅外段阻力指数PI(ICA)、颈内动脉颅外段舒张末期平均流速Vm(ICA)有一定意义,颈动脉阻力指数(PI)差值、颈内动脉颅外段舒张末期血液流速Vd(ICA)可较敏感地评估MCA狭窄,其中CCA的PI差值为0.13、ICA的PI差值为0.15、Vd(ICA)为13.8 cm/s时是诊断大脑中动脉重度狭窄或闭塞最佳界值,获得最大约登指数分别为0.709、0.710、0.601,敏感度分别为80.49%、78.05%、80.49%,特异度分别为90.48%、92.86%、78.57%,阳性预测值分别为89.20%、91.42%、78.57%,阴性预测值分别为82.60%、81.25%、80.48%。结论:大脑中动脉重度狭窄或闭塞患者其患侧颈总动脉、颈内动脉颅外段呈低流速高阻力血流信号改变,综合颈动脉阻力指数差值、Vd(ICA)、PI(ICA)、Vm(ICA)可对大脑中动脉重度狭窄或闭塞进行评估,为及早诊断提供依据。

Objective: By observing the relation between middle cerebral artery stenosis or occlusion patients with ipsilateral extracranial carotid artery hemodynamics changes, to identify the value of hemodynamic change of extracranial carotid artery in predicting the middle cerebral artery stenosis, in order to improve the detection rate and accuracy. Methods: Eighty-three patients with unilateral severe middle cerebral artery stenosis or occlusion who confirmed by MRA were enrolled in the study, in all case were detected by TCD. The relationship of hemodynamic between extracranial carotid arteries and intracranial carotid arteries were analyzed. Results: The patients with severe middle cerebral artery stenosis or occlusion tend to have lower velocity and higher pulsitility index (PI).The PI(ICA)、Vm(iCA) has a certain significance.The PI difference of carotid artery、end diastolic velocity of internal carotial arteryVd(ICA) can evaluate stenosis of MCAmore sensitive. The PI difference of common carotid artery=0.13,PI difference of internal carotid artery=0.15、Vd(ICA)=13.8 cm/s,Yonden index were 0.709、 0.710、 0.601;Sensitivity were 80.49%,78.05%,80.49%;Specificity were 90.48%,92.86%,78.57%;Positive predictive value were 89.20%,91.42%,78.57%;Negative predictive value were 82.60%,81.25%,80.48%. Conclusion:The patients tend to have lower velocity and higher PI. The PI difference of carotid artery、Vd(iCA)、PI(ICA)、Vm(ICA)severe middle cerebral artery stenosis or occlusion can be evaluated and provide a basis for the early diagnosis.