多发性大动脉炎颈动脉受累23例超声征象及误诊分析

Analysis of Ultrasound Signs and Misdiagnosis of 23 Cases of Carotid Artery Involvement in Takayasu's Arteritis

目的通过分析多发性大动脉炎(takayasu arteritis,TA)颈动脉受累患者的超声征象及误诊原因。方法回顾分析我院经影像学及临床证实的23例TA病例资料。结果本组23例均为女性,1例73岁患者有高血压病史,1例有颈部外伤史。15例超声首诊明确诊断,另8例误诊,误诊率35%,分别误诊为颈动脉夹层6例、真性动脉瘤及假性动脉瘤各1例。23例超声均可见动脉管壁增厚,造影可见明显强化。所有病例经数字减影血管造影(DSA)或CT检查并结合临床资料确诊为TA,其中9例行球囊扩张术,6例行支架植入术,4例行颈动脉旁路移植术,4例行药物保守治疗,手术治疗预后较差,轻症患者药物治疗预后较好。结论TA超声征象具有典型特征,超声造影可为临床治疗提供可靠依据,特别是当发现动脉管壁弥漫性增厚的年轻女性患者时,应想到本病可能并加以鉴别,确诊需结合CT、DSA检查结果及临床资料。

Objective To analyze the ultrasound features and causes of misdiagnosis of carotid artery involvement in Takayasu's arteritis(TA).Methods The clinical data of 23 TA cases confirmed by imaging and clinical analysis in our hospital were retrospectively analyzed.Results Of the 23 patients in this group,all were females,only 1 aged 73 years had a history of hypertension,and 1 had a history of neck trauma.Fifteen cases were diagnosed by ultrasound at initial visit,and 8 cases were misdiagnosed,with a misdiagnosis rate of 35%.They were misdiagnosed as cervical artery dissection(n=6),true aneurysm(n=1),and pseudoaneurysm(n=1).Ultrasound showed thickening of the arterial wall and angiography revealed significant enhancement in 23 cases.All cases were diagnosed as TA by digital subtraction angiography(DSA)or CT combined with clinical data.Nine of them underwent balloon dilatation,6 underwent stent implantation,4 underwent carotid artery bypass graft,and 4 received conservative drug treatment.Surgical treatment led to poor prognosis,while patients with mild symptoms had a better prognosis after drug treatment.Conclusion The ultrasound signs of TA have typical characteristics.Contrast-enhanced ultrasound can provide a reliable basis for clinical treatment.Especially when young female patients have diffuse thickening of the arterial wall,the possibility of this disease should be considered and identified.In addition,the diagnosis must be combined with results of CT and DSA as well as clinical data.