颈部血管彩超、经颅多普勒超声与脑血管造影的一致性分析

目的探讨颈部血管彩超、经颅多普勒超声(TCD)对颈动脉狭窄、椎-基底动脉狭窄和动脉粥样硬化斑块的诊断价值，分析其与脑血管造影的一致性。方法选取2019年1月~2020年6月106例动脉粥样硬化性脑梗死患者为观察组，53例无脑梗死的动脉粥样硬化高血压病和(或)高脂血症患者为对照组。比较两组颈部血管彩超和TCD对颈动脉与椎-基底动脉中重度以上狭窄、不稳定型斑块的检出率。以脑血管造影为金标准，分析颈部血管彩超和TCD的诊断一致性。结果观察组颈动脉与椎-基底动脉中度狭窄、重度狭窄、完全闭塞的检出率均高于对照组(P < 0.05)。观察组颈动脉粥样硬化不稳定型斑块的检出率高于对照组(P < 0.05)。颈部血管彩超联合TCD对中重度以上狭窄检出的敏感度为93.75%，特异性为88.46%，准确率为92.45%，一致性较高(Kappa=0.801)；对不稳定型斑块检出的敏感度为87.67%，特异性为87.88%，准确率为87.74%，一致性较高(Kappa= 0.725)。结论颈部血管彩超和TCD诊断颈动脉狭窄、椎-基底动脉狭窄和动脉粥样硬化斑块准确、无创、便捷，对脑梗死的预防、诊断、病因分析具有重要的参考意义。 

Consistency of carotid duplex ultrasound and transcranial Doppler with cerebral angiography

ObjectiveTo investigate the value of carotid duplex ultrasound and transcranial Doppler (TCD) in the diagnosis of carotid artery stenosis, vertebro-basilar artery stenosis and atherosclerotic plaque, and analyze their consistencies with cerebral angiography.Methods106 patients with atherosclerotic cerebral infarction who were treated between January 2019 and June 2020 were selected as the observation group. Meanwhile, 53 patients with atherosclerotic hypertension and/or hyperlipidemia and without cerebral infarction were selected as the control group. The detection rates of severer than moderate to severe stenosis of carotid artery and vertebro-basilar artery and unstable plaques by carotid duplex ultrasound and TCD were compared between the 2 groups. Cerebral angiography was taken as the golden standard to analyze the diagnostic consistency of carotid duplex ultrasound and TCD.ResultsThe detection rates of moderate stenosis, severe stenosis and complete occlusion of carotid artery and vertebro-basilar artery, and the detection rate of carotid atherosclerotic unstable plaques in the observation group were higher than those in the control group (P < 0.05). The sensitivity, specificity and accuracy of carotid duplex ultrasound combined with TCD in detection of severer than moderate to severe stenosis were 93.75%, 88.46% and 92.45%, with high consistency (Kappa=0.801). For detection of unstable plaques, the sensitivity, specificity and accuracy were 87.67%, 87.88% and 87.74%, with high consistency (Kappa=0.725).ConclusionCarotid duplex ultrasound and TCD are accurate, non-invasive and convenient in the diagnosis of carotid artery stenosis, vertebro-basilar artery stenosis and atherosclerotic plaque, which is of great significance for prevention, diagnosis and cause analysis of cerebral infarction.