经颅超声造影在后循环缺血患者椎-基底动脉病变诊断中的应用

目的探讨经颅超声造影对后循环缺血患者颅内椎-基底动脉病变的诊断价值。方法对39例临床诊断后循环缺血(PCI)患者分别行常规经颅彩色多普勒超声(TCCS)及经颅超声造影(CE-TCCS)检查,以数字减影血管造影(DSA)检查为"金标准",分别比较这两种检查方法对椎-基底动脉狭窄显示的符合程度,计算TCCS与CE-TCCS诊断椎-基底动脉狭窄的敏感度及特异度。比较TCCS与CE-TCCS间椎-基底动脉不同程度狭窄时收缩期峰值流速(PSV)的差异。结果 39例患者共117支椎-基底动脉(78支椎动脉和39支基底动脉),以DSA为金标准,TCCS诊断椎-基底动脉狭窄与DSA的吻合系数Kappa=0.515,P<0.01;CE-TCCS诊断椎-基底动脉狭窄与DSA的吻合系数Kappa=0.788,P<0.01。TCCS诊断颅内椎-基底动脉狭窄的敏感度为66.7%(32/48),特异度为84.1%(58/69),阳性预测值为74.4%(32/43),阴性预测值为78.4%(58/74);CE-TCCS诊断颅内椎-基底动脉狭窄的敏感度为87.5%(42/48),特异度为91.3%(63/69),阳性预测值为87.5%(42/48),阴性预测值为91.3%(63/69)。在颅内椎-基底动脉狭窄程度<50%时,CE-TCCS测量的收缩期峰值流速高于TCCS的测量值,两者比较差异有统计学意义(Z=-6.181,P<0.01);在颅内椎-基底动脉狭窄程度≥50%时,CE-TCCS测量的收缩期峰值流速亦高于TCCS的测量值,两者比较差异有统计学意义(Z=-3.180,P<0.05)。结论与TCCS比较,CE-TCCS在诊断椎-基底动脉狭窄方面与DSA结果显示出更好的一致性。CE-TCCS检查有助于提高PCI患者颅内椎-基底动脉病变的诊断。

Application of contrast-enhanced transcranial color sonography in diagnosing intracranial vertebral-basilar lesions of patients with posterior circulation ischemia

Objective To explore the clinical value of contrast-enhanced transcranial color sonography（CE-TCCS） in diagnosing intracranial vertebro-basilar lesions in patients with posterior circulation ischemia （PCI） .Methods Transcranial color sonography（TCCS） and CE-TCCS were performed in 39 patients with PCI.As the gold standard,the results of digital subtraction angiography（DSA） were compared to those of TCCS and CE-TCCS,respectively,and the consistencies were calculated.The sensitivities and specificities of TCCS and CE-TCCS in diagnosing intracranial vertebro-basilar lesions were also calculated.The peak systolic velocities which were measured in ≥50% and〈50% intracranial vertebral-basilar stenosis between TCCS and CE-TCCS were compared.Results A total of 39 patients were included,including 117 vertebral-basilar arteries（78 vertebral arteries and 39 basilar arteries）.The Kappa value between TCCS and angiography was 0.515（P〈0.01） and the Kappa value between CE-TCCS and angiography was 0.788（P〈0.01）.The sensitivity and specificity in diagnosing vertebral-basilar stenosis by TCCS was 66.7%（32/48）and 84.1%（58/69） respectively;and the positive predictive value and negative predictive value was 74.4%（32/43）and 78.4%（58/74）respectively.The sensitivity and specificity in diagnosing vertebral-basilar stenosis by CE-TCCS was 87.5%（42/48）and 91.3%（36/69）,and the positive predictive value and negative predictive value was 87.5%（42/48）and 91.3%（63/69）respectively.For detecting〈50% intracranial vertebral-basilar stenosis,the peak systolic velocities increased after the administration of contrast material in all patients（Z=-6.181,P〈0.01）.The same results were obtained for detecting≥50% intracranial vertebral-basilar stenosis（Z=-3.180,P〈0.05）.Conclusions In diagnosing intracranial vertebral-basilar stenosis,CE-TCCS showed higher consistency with angiography compared to that of TCCS.CE-TCCS can help to improve the accuracy of diagnosing intracranial vertebral-basilar lesions in patients with PCI.