彩色多普勒血流显像对椎动脉发育不良的检测

目的探讨椎动脉先天性发育不良对椎动脉颅外段血流动力学的影响。方法选择2008年4月1日-6月30日，首都医科大学宣武医院血管超声诊断科应用多普勒血流显像（CDFI），连续检测可疑后循环缺血的脑血管病患者5500例，从中筛查出一侧椎动脉发育不良者288例。比较双侧椎动脉椎间隙段的管径、收缩期峰值流速（PSV）、舒张期流速（EDV）、阻力指数（RI）及血流频谱的差异。结果①椎动脉发育不良侧平均管径为（2．21±0．20）mm，与健侧管径（3．39±0．47）mm比较，差异有统计学意义（P〈0．01）。②288例患者中，发育不良侧管径≤2．0mm者61例（21．2％），2．0mm〈管径≤2．5mm者227例（78．8％），P〈0．01；左侧发育不良者81例（28．1％），右侧207例（71．9％），P〈0．01；女性162例（56．3％），男性126例（43．7％），P〈0．05。③发育不良侧椎动脉椎间隙段PSV、EDV及RI为（52±11）、（17±6）cm／s及0．66±0．07，健侧分别为（59±10）、（23±5）cm／s及0．61±0．06，均P〈0．01。发育不良侧椎动脉椎间隙段为高阻力型血流频谱改变。结论椎动脉发育不良可引起椎动脉血流动力学变化。

Evaluation of vertebral artery hypoplasia by color Doppler ultrasonography

Objective To evaluate the diagnostic value about congenital vertebral artery hypoplasia （VAH） by color Doppler flow image （CDFI）. Methods A total of 288 patients with congenital unilateral vertebral artery hypoplasia were examined by color Doppler flow image. They were selected from 5500 patients with suspected posterial circulation ischemia from Apr. to Jun. 2008 in this study. The diameter, peak systolic velocity （PSV） , end diastolic velocity （EDV） and resistance index （RI） at intervertebral segment of the vertebral arteries were compared between the normal and hypoplastic vertebral artery. Results （1）The mean diameter of hypoplastic VA was 2.21 ± 0.20 mm, it was much smaller than that of the normal VA 3.39 ± 0.47 mm significantly （ t = - 39. 746, P 〈 0.01 ）. （2） Among 288 patients with VAH, the patients with diameter of the vertebral arteries between 2.0 mm and 2.5 mm （ 227/288 cases ） were more than patients with diameter less than 2.0 mm （61/288 cases）, and the hypoplasia was more often detected in the right VA （207/288 cases） than in the left VA （81/288 cases）, and more common in the female （ 162/288 cases） than in the male patients （ 126/288 cases）. （3）The PSV and EDV of hypoplastic VA were lower than those of normal VA, of which the PVS were 52 ± 11 em/s vs 59 ±10 cm/s, the EDV were 17 ±6 cm/s vs 23 ±5 cm/s （P 〈0.01 ） ,respectively, but the RI of hypoplastic VA was 0. 66 ± 0.07, which was higher than that of normal VA （ 0.61 ± 0.06 ） （ P 〈 0.01 ）. Conclusion Congenital vertebral artery hypoplasia may cause abnormal hemodynamics of extracranial vertebral artery. Color Doppler Ultrasonography is an objective method to evaluate it.