颈动脉彩色多普勒超声、颈部CT血管成像及脑部CT灌注成像在脑梗死并发颈动脉狭窄患者中的应用研究

Application of carotid color Doppler ultrasound,neck CT angiography,and brain CT perfusion imaging in patients with cerebral infarction complicated by carotid stenosis

目的按探讨颈动脉血管超声、头颈部CT血管成像(CTA)及CT灌注成像(CTP)在脑梗死并颈动脉狭窄患者中的应用效果。方法回顾性分析2022年3月至8月宿迁市第一人民医院收治的脑梗死且颈动脉血管超声提示颈动脉狭窄的80例患者的临床资料。颈动脉血管超声检查后2d内行CTA及CTP检查,分别评价颈动脉狭窄程度(轻度、中度、重度和闭塞)。另选择同期本院健康体检者40名作为对照。采用Kappa检验评价颈动脉血管超声与CTA评价颈动脉狭窄程度的一致性,采用方差分析或秩和检验比较健康体检者和不同程度颈动脉狭窄患者的血流动力学指标的差异,组间两两比较采用LSD-t检验或秩和检验。结果80例患者(160支颈内动脉)行CTA及颈动脉血管超声检查,正常者分别为68支和64支,轻度狭窄者34支和30支,中度狭窄者43支和38支,重度狭窄者13支和17支,闭塞者6支和7支,CTA与颈动脉血管超声检查一致性较高(Kappa=0.794)。颈动脉血管超声检查结果显示,不同颈动脉狭窄程度(轻度、中度、重度)患者颈内动脉收缩期峰值流速、舒张末期流速高于健康体检者[(93.43±12.43)cm/s vs(163.43±23.43)cm/svs(263.67±34.97)cm/svs(51.43±6.43)cm/s;(65.74±11.54)cm/svs(71.73±19.24)cm/svs(124.63±26.37)cm/svs(23.03±3.53)cm/s],且重度狭窄患者高于中度狭窄患者,中度狭窄患者高于轻度狭窄患者,差异均具有统计学意义(P均<0.001);重度狭窄和闭塞患者大脑中动脉搏动指数、平均血流速度均低于健康体检者、轻度狭窄及中度狭窄患者[(0.56±0.02)vs(0.53±0.02)vs 0.10(0.07,0.58)vs 0.07(0.03,0.36)vs 0.09(0.04,1.06);(42.43±6.95)cm/s vs(40.04±6.81)cm/svs(58.43±4.53)cm/svs(56.05±6.54)cm/svs(52.73±5.83)cm/s],差异均具有统计学意义(P均<0.001)。重度狭窄或闭塞患者的额叶、题叶、基底节区的脑血容量、平均通过时间、达峰时间高于健康体检者及轻度、中度颈动脉狭窄患者[额叶脑血容量:(4.53±1.05)mlvs(4.67±1.21)mlvs(2.45±0.68)mlvs(2.45±0.68)mlvs(2.62±0.47)ml;叶脑血容量:(4.75±1.34)mlvs(4.93±1.29)mlvs(3.75±0.74)mlvs(2.95±0.43)mlvs(2.85±0.64)ml;基底节区脑血容量:(4.23±1.33)mlvs(4.33±1.01)mlvs(3.63±0.53)mlvs(3.85±0.51)mlvs(3.93±0.43)ml;额叶平均通过时间:(7.43±0.43)svs(7.62±2.01)svs(4.12±0.75)svs(4.36±0.63)svs(4.43±0.56)s;题叶平均通过时间:(7.63±0.43)svs(7.32±1.14)svs(3.63±0.43)svs(3.74±0.54)svs(4.61±0.67)s;基底节区平均通过时间:(8.24±0.45)s vs(8.24±1.42)svs(3.62±0.46)svs(3.81±0.61)svs(3.64±0.36)s;额叶达峰时间:(11.43±0.42)svs(12.02±2.31)svs(9.25±0.48)svs(9.33±0.42)svs(9.62±0.31)s;叶达峰时间:(11.45±0.84)svs(12.41±2.03)svs(9.32±0.43)svs(9.35±0.32)svs(9.82±0.44)s;基底节区达峰时间:(12.05±1.04)svs(12.64±1.57)svs(9.32±0.55)svs(9.41±0.61)svs(9.43±0.64)s),差异有统计学意义(P均<0.001);重度狭窄或闭塞患者的脑血流量低于健康体检者及轻度、中度狭窄患者[额叶:(45.43±5.43)mlvs(42.72±1.04)ml vs(51.63±6.37)ml vs(48.05±4.65)ml vs(48.48±4.36)ml;题叶:(46.43±3.43)mlvs(43.93±1.43)mlvs(64.63±8.37)mlvs(63.54±5.54)mlvs(64.65±6.67)ml;基底节区:(46.43±4.45)mlvs(43.23±1.24)mlvs(65.83±8.36)mlvs(63.54±6.64)mlvs(63.64±5.36)ml],差异均具有统计学意义(P均<0.001)。结论颈动脉血管超声、CTA及CTP可以帮助临床医师更清楚地了解脑梗死并颈动脉狭窄患者血流动力学状态,评价颈动脉狭窄程度,为临床提供有效影像学证据。

Objective To investigate the effect of carotid artery ultrasound,neck CT angiography(CTA)and computerized tomography perfusion(CTP)in patients with cerebral infarction and carotid artery stenosis.Methodss The clinical data of 80 patients with cerebral infarction and carotid artery stenosis diagnosed by carotid artery ultrasound admitted to Suqian First People's Hospital from March to August 2022 were analyzed retrospectively.Within 2 days of carotid artery ultrasound examination,CTA and CTP examinations were performed to evaluate the degree of carotid artery stenosis(mild,moderate,severe and occlusion).Additionally,40 health examinees from our hospital were selected for the same period.The Kappa test was used to evaluate the consistency between carotid artery ultrasound and CTA in evaluating the degree of carotid artery stenosis.ANOVA and rank test were used to compare the differences in hemodynamic indicators between healthy individuals and patients with different degrees of carotid artery stenosis.Pairwise comparisons between groups were performed using the LSD-t test or the rank-sum test.Results In eighty patients(160 internal carotid arteries),68 and 64 normal carotid arteries were examined by CTA and carotid artery ultrasound respectively,34 and 30 with mild stenosis,43 and 38 with moderate stenosis,13 and 17 with severe stenosis,6 and 7 with occlusion,and the consistency between CTA and carotid artery ultrasound was high(Kappa=0.794).The results of carotid artery ultrasound showed that the peak systolic flow rate and end diastolic flow rate of internal carotid artery in patients with different degrees of carotid artery stenosis(mild,moderate and severe)were higher than those in healthy people[(93.43±12.43)cm/s vs(163.43±23.43)cm/s vs(263.67±34.97)cm/s vs(51.43±6.43)cm/s;(65.74±11.54)cm/s vs(71.73±19.24)cm/s vs(124.63±26.37)cm/s vs(23.03±3.53)cm/s),Moreover,patients with severe stenosis were higher than those with moderate stenosis,and patients with moderate stenosis were higher than those with mild stenosis,with statistically significant differences(all P<0.001);Patients with severe stenosis and occlusion had lower pulsatile index and average blood flow velocity of the middle cerebral artery compared to healthy individuals and patients with mild and moderate stenosis[(0.56±0.02)vs(0.53±0.02)vs 0.10(0.07,0.58)vs 0.07(0.03,0.36)vs 0.09(0.04,1.06);(42.43±6.95)cm/s vs(40.04±6.81)cm/s vs(58.43±4.53)cm/s vs(56.05±6.54)cm/s vs(52.73±5.83)cm/sl,the difference was statistically significant(all P<0.001).The cerebral blood volume,average transit time,and basal ganglia area of patients with severe or occlusive disease peak time was higher than that of healthy individuals and carotid artery stenosis(mild to moderate)[(4.53±1.05)ml vs(4.67±1.21)ml vs(2.45±0.68)ml vs(2.62±0.47)ml vs(2.45±0.68)ml;(4.75±1.34)ml vs(4.93±1.29)ml vs(3.75±0.74)ml vs(2.95±0.43)ml vs(2.85±0.64)ml;(4.23±1.33)ml vs(4.33±1.01)ml vs(3.63±0.53)ml vs(3.85±0.51)ml vs(3.93±0.43)ml;(7.43±0.43)s vs(7.62±2.01)s vs(4.12±0.75)s vs(4.36±0.63)s vs(4.430.56)s;(7.63±0.43)s vs(7.32±1.14)s vs(3.63±0.43)s vs(3.74±0.54)s vs(4.61±0.67)s;(8.24±0.45)s vs(8.24±1.42)s vs(3.62±0.46)s vs(3.81±0.61)s vs(3.64±0.36)s;(11.43±0.42)s vs(12.02±2.31)s vs(9.25±0.48)s vs(9.33±0.42)s vs(9.62±0.31)s;(11.45±0.84)s vs(12.41±2.03)s vs(9.32±0.43)s vs(9.35±0.32)s vs(9.82±0.44)s;(12.05±1.04)s vs(12.64±1.57)s vs(9.32±0.55)s vs(9.41±0.61)s vs(9.43±0.64)s),the difference was statistically significant(all P<0.001);The cerebral blood flow of severe or occlusive patients is lower than that of healthy individuals,mild and moderate stenosis[(45.43±5.43)ml vs(42.72±1.04)ml vs(51.63±6.37)ml vs(48.05±4.65)ml vs(48.48±4.36)ml;(46.43±3.43)ml vs(43.93±1.43)ml vs(64.63±8.37)ml vs(63.54±5.54)ml vs(64.65±6.67)ml;(46.43±4.45)ml vs(43.23±1.24)ml vs(65.83±8.36)ml vs(63.54±6.64)ml vs(63.64±5.36)ml),the difference was statistically significant(all P<0.001).Conclusion Carotid artery ultrasound,CTA and CTP can help clinicians better understand the hemodynamic status of cerebral infarction with carotid artery stenosis,evaluate the degree of carotid artery stenosis,and provide effective imaging evidence for clinical use.