血管超声与脑血管造影诊断颈动脉狭窄的对比研究

目的评价血管超声技术与脑血管造影诊断颈动脉狭窄的临床应用价值。方法回顾性分析130例缺血性脑血管病患者的颈部血管超声和数字减影血管造影术(DSA)检查结果 ,评价血管超声诊断颈动脉狭窄的价值。颈动脉狭窄率及狭窄程度分级按北美症状性颈动脉内膜剥脱术进行计算。结果 130例患者中,260支颈动脉行2种检查,DSA检查显示63例患者颈动脉狭窄,狭窄血管71支,血管超声检查显示56例患者颈动脉狭窄,狭窄血管70支。以DSA检查结果为金标准,血管超声诊断颈内动脉狭窄的敏感性、特异性和准确性分别为71.88%、94.47%和88.97%。血管超声诊断中、重度颈内动脉狭窄的敏感性、特异性和准确性分别为55.56%、99.20%和97.69%。以DSA诊断结果为标准,血管超声诊断颈总动脉狭窄的敏感性为100%,特异性为97.6%,准确性为97.69%。结论血管超声诊断颈动脉狭窄的敏感性较高,诊断颈总动脉狭窄的敏感性高于颈内动脉,可用于颈动脉狭窄的筛选和随访,但对于血管重度狭窄和闭塞诊断仍欠佳,尚不能取代DSA检查。

Diagnosis of carotid artery stenosis:A comparative study of duplex utrasonography and digital subtraction angiography

Objective To assess the clinical application of duplex ultrasonography and digital subtraction angiography(DSA) in diagnosis of carotid artery stenosis(CAS).Methods Duplex ultra-sonography and DSA findings in 130 patients with ischemic cerebral vascular diseases were retrospectively analyzed.Value of duplex ultrasonography for the diagnosis of CAS was assessed.CAS and its severity were assessed according to the North American symptomatic carotid endarterectomy trial criteria.Results Two hundred and sixty carotid arteries in the 130 patients underwent duplex ultrasonography and DSA.DSA showed CAS in 63 patients(71 carotid arteries) and duplex ultrasonography showed CAS in 56 patients(70 carotid arteries).The sensitivity,specificity and accuracy of duplex ultrasonography were 71.88%,94.47%,88.97%respectively for the diagnosis of common CAS and 55.56%,99.20%,97.69%respectively for the diagnosis of severe CAS when the DSA findings were used as the gold criteria,and 100%,97.6%,97.69%respectively for the diagnosis of CAS when the DSA findings were used as the common criteria.Conclusion The sensitivity of duplex ultrasonography is rather high for the diagnosis of CAS and higher for the diagnosis of common carotid artery stenosis than for the diagnosis of internal carotid artery stensis and can thus be used in screening and folloing up CAS.However,its sensitivity for the diagnosis of severe CAS is not high and therefore cannot replace DSA.