两种影像检查对短暂性脑缺血发作颈动脉狭窄的诊断价值

目的 评价颈部血管彩色多普勒超声(彩超)、磁共振血管成像(MRA)对短暂性脑缺血发作(TIA)患者颅外段颈动脉狭窄的价值.方法 选择同时经彩超、MRA检查,并且至少1项检查发现有颅外段颈动脉狭窄的45例TIA患者,再进行全脑数字减影血管造影(DSA),按照北美症状性颈动脉狭窄内膜切除试验(NASCET)计算颅外段颈动脉狭窄率.结果 以DSA诊断为金标准,45例TIA患者180条颅外段颈动脉狭窄分级,诊断的敏感度93.51%,特异度95.15%,准确度94.44%,Kappa=0.735;MRA诊断的敏感度92.21%,特异度94.17%,准确度93.33%,Kappa=0.681;彩超联合MRA诊断的敏感度97.40%,特异度99.03%,准确度98.33%,Kappa=0.872.结论 彩超诊断颅外段颈动脉狭窄的敏感度、准确度均高于MRA,适用于人群初选检查;彩超联合MRA诊断颅外段颈动脉狭窄与DSA一致性较好,但不能完全取代DSA.

Diagnostic value of two kinds of imaging of extracranial carotid artery stenosis in patients with transient ischemic attack

Objective To evaluate the value of neck blood vessel colored doppler ultrasound (NBVCDU) and magnetic resonance angiography (MRA) to extracranial carotid artery stenosis in patients with transient ischemic attack (TIA).Methods After implementing NBVCDU and MRA examinations at the same time,45 TIA patients with at least one examination showing arteriostenosis in extracranial section were chosen to carry out cerebral digital subtraction angiography( DSA ),then the stenosis rate was calculated by American symptomatic carotid endarterectomy trial (NASCET) method.Results Regarding DSA as the gold standard,for 45 TIA patients that having 180 arteriostenosis in extracranial section, sensitivity,specificity,accuracy of NBVCDU examination was 93.51% ,95.15% ,94.44%, Kappa = 0.735; sensitivity,specificity,accuracy of MRA was 92.21% ,94.17% ,93.33% , Kappa =0.681; sensitivity,specificity,accuracy of NBVCDU combined with MPA was 97.40% ,99.03% ,98.33%, Kappa = 0.872.Conclusions The sensitivity and accuracy of arteriostenosis in extracranial section by NBVCDU examination is higher than that by MRA, and it is suitable in the crowd primary examination.NBVCDU combined with MRA has shown good consistence with DSA for diagnosing arteriostenosis in extracranial section,but can't replace DSA comlpetely.