高低频超声联用诊断椎动脉起始段狭窄的价值

目的对比高低频超声联合使用与数字减影血管造影对椎动脉起始段狭窄的检测结果,探讨高低频超声联合应用在椎动脉起始段病变检测中的使用价值。方法 2006年7月至2010年12月我院经血管造影检查确诊为椎动脉起始段狭窄患者42例,均常规行颈部血管彩色多普勒超声检查。采用Kappa检验评价联合应用高低频率超声检查与DSA对VA起始段狭窄诊断的一致性。结果椎动脉起始段狭窄病变显示管腔迂曲,伴有动脉硬化可见血管内膜增厚,回声增强,有小的斑块形成;彩色多普勒表现为椎动脉内血流变细;频谱多普勒显示狭窄近段血流速度增高,远段流速减低。椎动脉闭塞表现为无彩色血流显示。联合应用高低频率超声检查诊断为椎动脉起始段轻度狭窄25例(59.5%),中重度狭窄14例(33.3%),闭塞3例(7.1%),其中3例轻度狭窄患者、1例中重度狭窄患者为应用低频凸阵探头后发现。血管造影诊断为椎动脉起始段轻度狭窄26例,中重度狭窄14例,闭塞2例。高低频超声联合应用与血管造影对椎动脉起始段狭窄的检测一致性较好(κ=0.77>0.75)。结论高低频超声联合应用可作为椎动脉起始部狭窄的重要诊断手段。

Value of multi-frequency probe in detecting stenosis of the first segment of the vertebral artery

Objective To evaluate the clinical significance of multi-frequency probe in detecting the stenosis of the first segment （V1） of the vertebral artery（VA）.Methods The neck vascular color Doppler ultrasound exams were performed in 42 cases patients from July 2006 to December 2010 in our hospital diagnosed as the first part of the VA stenosis by angiography. Kappa consistency test evaluation was used for combining high and low frequency ultrasound and digital subtraction angiography （DSA） for diagnosis of the first part of VA stenosis.Results VA stenosis results showed lumen tortuous lesions, visible blood vessels associated with atherosclerosis, intimal thickening, echogenic, small plaque formation; color Doppler showed blood flow within the VA thinning; Spectrum Doppler showed increased blood flow velocity in the proximal stenosis, and distal flow reduction. VA occlusion showed no color flow display. Combined high and low frequency ultrasound mild stenosis of VA segment in 25 cases （59.5%） was diagnosed, severe stenosis in 14 patients （33.3%）, and occlusion in 3 cases （7.1%）.Of those 3 patients with mild stenosis, 1 patient with moderate to severe stenosis was found with application of low-frequency probe. Angiography in the diagnosis of mild stenosis of VA segment was found in 26 cases, moderate to severe stenosis in 14 cases, occlusion in 2 cases. The combination of high and low frequency probes has the good accordance with the result of DSA, and κ=0.770.75. Conclusion High frequency ultrasound can be combined with VA stenosis as an important diagnostic tool.