超声检查颈内静脉呼吸变异性与颅内静脉窦的关系

Correlation between respiratory variation of internal jugular vein and intracranial venous sinus

目的:应用超声研究颈内静脉呼吸变异性与颅内静脉窦狭窄的关系。方法:纳入2016年1月至2021年7月期间在武汉大学中南医院就诊患者,均行头颈静脉磁共振静脉成像(MRV)和颈内静脉超声检查,颅内静脉狭窄组21例,正常对照组21例。应用灰阶超声测量颈内静脉的最大截面积(Amax)、最小截面积(Amin),计算颈内静脉的呼吸变异指数(RVI)。比较两组间超声参数的差异性,运用受试者工作特征曲线(ROC)和一致性分析评价颈内静脉截面积、呼吸变异指数与颅内静脉窦狭窄的关系。结果:颈内静脉的Amax、Amin及RVI在两组间的差异有统计学意义,其中狭窄组颈内静脉Amin明显小于对照组(P=0.0007),狭窄组RVI明显大于对照组(P=0.0338),狭窄组颅内静脉窦直径明显小于对照组(P<0.0001)。ROC分析提示Amin、RVI预测颅内静脉窦狭窄的效能好,相应阈值分别为0.065 cm;(敏感度76.2%,特异度85.7%,阳性预测值为94.1%,阴性预测值为80.0%,准确性为85.7%)和0.945(敏感度47.6%,特异度95.2%,阳性预测值为84.6%,阴性预测值为65.5%,准确性为71.4%)。与MRV结果相比较,Amax的一致性较高(kappa值为0.714,P<0.0001)。结论:颈内静脉呼吸变异性与同侧颅内静脉窦的狭窄相关,提示脑静脉回流量是影响颈内静脉呼吸时相管径变化的主要因素。

Objective:To study the correlation between respiratory variability of internal jugular vein(IJV)and intracranial venous sinus stenosis with ultrasonography.Methods:Patients in Zhongnan Hospital of Wuhan University from January 2016 to July 2021 were included.All patients underwent head and neck vein magnetic resonance venography(MRV).There were 21 cases in intracranial venous sinus stenosis group and 21 cases in normal control group.The maximum cross-sectional area(Amax)and the minimum cross-sectional area(Amin)of IJV were measured by gray-scale ultrasound,and the respiratory variation index(RVI)of IJV was calculated.The differences of the above ultrasonic parameters between the two groups were compared,and the relationship between intracranial venous sinus stenosis and respiratory variability of IJV was analyzed.Results:There was significant difference in Amax,Amin,and RVI of IJV between the two groups.Compared with that respectively in control group,Amin of IJV was significantly lower(P=0.0007),RVI of IJV was higher(P=0.0338),and the diameter of intracranial venous sinus was significantly lower(P<0.0001)in intracranial venous sinus stenosis.Receiver operating characteristic curve(ROC)analysis showed that Amin and RVI were effective in predicting intracranial venous sinus stenosis.The corresponding thresholds were 0.065cm2(sensitivity 76.2%,specificity 85.7%,positive predictive value 94.1%,negative predictive value 80.0%,and accuracy 85.7%)and 0.945(sensitivity 47.6%,specificity 95.2%,positive predictive value 84.6%,negative predictive value 65.5%,and accuracy 71.4%).Compared with MRV results,Amax had the higher consistency(kappa=0.714,P<0.0001).Conclusion:The respiratory variability of internal jugular vein is correlated with the stenosis of ipsilateral intracranial venous sinus,suggesting that cerebral venous reflux was the main factor affecting the change of IJV respiratory phase diameter.