彩色多普勒超声在颈动脉狭窄诊断中的应用价值分析

Color Doppler flow imaging in diagnosis of carotid artery stenosis

目的探讨彩色多普勒超声(CDFI)诊断颈动脉狭窄的准确性和应用价值。方法选择解放军海军第九七一医院神经外科自2013年1月至2019年7月行颈动脉CDFI和DSA检查的脑梗死或短暂性脑缺血发作(TIA)患者172例,将患者按颈动脉狭窄程度分为6类:正常、轻度狭窄(狭窄程度<30%)、中度狭窄(狭窄程度为30%~69%)、重度狭窄(狭窄程度为70%~94%)、次全闭塞(狭窄程度为95%~99%)和完全闭塞(狭窄程度为100%),比较CDFI和DSA对颈动脉狭窄的检出率,并以DSA为金标准探讨CDFI诊断颈动脉狭窄的准确性及采用Kappa分析评价2种检测结果的一致性。结果172例患者共计344条颈内动脉中,CDFI检查显示正常179条,轻度狭窄15条,中度狭窄66条,重度狭窄61条,次全闭塞13条,完全闭塞10条;DSA检查显示正常160条,轻度狭窄32条,中度狭窄84条,重度狭窄45条,次全闭塞14条,完全闭塞9条;CDFI和DSA对颈动脉狭窄的检出率(48.0%vs.53.5%)差异无统计学意义(P>0.05)。CDFI诊断颈动脉狭窄的准确度为94.5%,灵敏度为89.7%,特异度为100%。DSA检查和CDFI检查结果的一致性较好,差异有统计学意义(P<0.05)。结论CDFI检查无创、性价比高,与DSA检查结果一致性较好,可作为颈动脉狭窄术前筛查、术后随访的首选方法。

Objective To investigate the accuracy and application value of color Doppler flow imaging(CDFI)in diagnosis of carotid artery stenosis.Methods A retrospective analysis was performed on the clinical data of 172 patients with cerebral infarction or transient ischemic attack(TIA)underwent both CDFI and cerebral digital subtraction angiography(DSA)in our hospital from January 2013 to July 2019.The carotid arteries from these patients were classified into 6 categories:normal type,mild stenosis(stenosis degree<30%),moderate stenosis(stenosis degree:30%-69%),severe stenosis(stenosis degree:70%-94%),subtotal occlusion(stenosis degree:95%-99%),and total occlusion(stenosis degree:100%).The detection rates of carotid artery stenosis by CDFI and DSA were compared;and using DSA result as the gold standard,the accuracy of CDFI in diagnosing carotid artery stenosis was discussed.Kappa analysis was used to evaluate the consistency of the two detection methods.Results A total of 344 carotid arteries were detected in the 172 patients.CDFI examinations showed that 179 were normal,15 were with mild stenosis,66 were with moderate stenosis,61 were with severe stenosis,13 were with subtotal occlusion,and 10 were with total occlusion.DSA showed that 160 were normal,32 were with mild stenosis,84 were with moderate stenosis,45 were with severe stenosis,14 were with subtotal occlusion,and 9 were with total occlusion.The vascular stenosis detection rate of DSA was 53.5%(184/344),and that of CDFI was 48.0%(165/344),without significant difference(P>0.05).Using DSA result as the gold standard,the accuracy,sensitivity and specificity of CDFI in diagnosing carotid stenosis were 94.5%,89.7%and 100%respectively.Consistency analysis showed that Kappa was 0.846,and the consistency of DSA and CDFI detection results was high.Conclusions CDFI is a non-invasive and cost-effective method for diagnosing carotid artery stenosis,enjoying high consistency with DSA.CDFI can be used as the first choice for preoperative screening and postoperative follow-up of carotid artery stenosis.