颈脑超声联合诊断在评估颈内动脉颅内段重度狭窄或闭塞中的应用

Application of Combined Diagnosis of Cervico-Cerebral Ultrasound in Evaluating Severe Stenosis or Occlusion of Intracranial Segment of Internal Carotid Artery

目的探讨应用颈部血管超声联合经颅多普勒(TCD)评价颈内动脉(ICA)颅内段重度狭窄或闭塞的诊断价值。方法回顾性分析苏州大学附属第一医院2018年1月至2019年10月38例经数字减影血管造影(DSA)证实的单侧颈内动脉重度狭窄或闭塞患者的超声结果,颈部血管超声分析两侧颈内动脉管径、收缩期峰值流速(PSV)及舒张末期流速(EDV)、阻力指数(RI);TCD主要分析颈内动脉终末段至大脑中动脉的平均血流速(MV)、PSV、搏动指数(PI)。结果①颈部超声示27例两侧颈内动脉的管径、PSV、EDV、RI差异有统计学意义(P<0.05);②TCD示31例两侧大脑中动脉的MV、PSV、PI差异有统计学意义(P<0.05);③与DSA比较,颈部血管超声诊断颈内动脉颅内段重度狭窄或闭塞符合率为71.0%,联合检查结果符合率为97.3%。结论颈脑超声联合检查对颈内动脉颅内段重度狭窄或闭塞的诊断有重要价值。

Objective To investigate the diagnostic value of cervical vascular ultrasound combined with transcranial Doppler(TCD)in the evaluation of severe intracranial stenosis or occlusion of internal carotid artery(ICA).Methods The ultrasonographic results of 38 patients from January 2018 to October 2019 in First Affiliated Hospital of Suzhou University with severe unilateral ICA stenosis or occlusion confirmed by digital subtraction angiography(DSA)were retrospectively analyzed.The diameter,peak systolic velocity(PSV),end of diastolic velocity(EDV)and resistance index(RI)of bilateral ICA were analyzed.TCD mainly analyzed the mean velocity(MV),PSV and pulsatility index(PI)from the end of ICA to middle cerebral artery.Results①The diameter,PSV,EDV and RI of bilateral ICA were significantly different in 27 cases by cervical ultrasound(P<0.05).②MV,PSV and PI of bilateral middle cerebral artery in 31 cases were significantly different by TCD(P<0.05).③Compared with DSA,the coincidence rate of carotid artery ultrasound in diagnosis of severe intracranial stenosis or occlusion of ICA was 71.0%,and the coincidence rate of combined examination was 97.3%.Conclusion The combined examination of carotid and cerebral ultrasound is of great value in the diagnosis of severe intracranial stenosis or occlusion of ICA.