经颅多普勒在颈内动脉颅外段病变侧支循环建立的诊断价值

目的探究经颅多普勒在颈内动脉颅外段病变侧支循环建立的诊断价值。方法选取2017年11月—2019年12月于我院进行检查的颈内动脉颅外段病变患者175例,所有患者均行DSA及经颅多普勒超声检查。以DSA检查为诊断颈内动脉颅外段病变"金标准",分析DSA及经颅超声检查结果,另分析经颅多普勒超声在前交通动脉、后交通动脉、颈内外侧支开放诊断价值及颅外段病变程度及侧支循环情况。结果DSA共检出前交通动脉开放125例,后交通动脉开放88例,颈内外动脉侧支开放76例;经颅多普勒超声检查共检出前交通动脉开放86例,后交通动脉开放98例,颈内外侧支开放74例。经颅多普勒超声在前交通动脉诊断中灵敏度为64.80%、特异度为90.00%、准确度为72.00%、假阳性率为10.00%、假阴性率为35.20%;后交通动脉诊断中灵敏度为89.77%、特异度为78.16%、准确度为84.00%、假阳性率为21.84%、假阴性率为10.23%;颈内外动脉侧支开放诊断中灵敏度为88.16%、特异度为92.93%、准确度为90.86%、假阳性率为7.07%、假阴性率为11.84%;重度狭窄或闭塞患者有侧支循环开放率高于轻中度狭窄者,而轻中度狭窄者无侧支循环开放率高于重度狭窄或闭塞者,差异有统计学意义(χ;=9.526,P=0.002)。结论经颅多普勒在颈内动脉颅外段病变侧支循环建立评估中具有较高的临床应用价值,可将其作为疾病诊断的重要方法,值得推广应用。

Diagnostic value of transcranial Doppler in establishment of collateral circulation in extracranial segment of internal carotid artery

Objective To explore the value of transcranial Doppler (TCD) in the diagnosis of collateral circulation in extracranial segment of internal carotid artery. Methods From November 2017 to December 2019, 175 patients with extracranial internal carotid artery lesions were selected. All the patients underwent digital substraction angiography (DSA) and TCD. DSA was the gold standard for the diagnosis of extracranial lesions of internal carotid artery. The results of DSA and transcranial ultrasound were analyzed. In addition, the diagnostic value of TCD ultrasound in the opening of anterior communicating artery, posterior communicating artery, internal and external carotid collateral branches, the extent of extracranial segment lesions and collateral circulation were analyzed. Results DSA detected 125 cases of anterior communicating artery opening, 88 cases of posterior communicating artery opening, and 76 cases of internal and external carotid artery collateral opening; TCD ultrasound detected 86 cases of anterior communicating artery opening, 98 cases of posterior communicating artery opening, and 74 cases of internal and external carotid collateral opening. The sensitivity, specificity, accuracy, false positive rate, and false negative rate of TCD in the diagnosis of anterior communicating artery were 64.80%, 90.00%, 72.00%, 10.00% and 35.20% respectively; the sensitivity, specificity, accuracy, false positive rate, and false negative rate of TCD in the diagnosis of posterior communicating artery were 89.77%, 78.16%, 84.00%, 21.84% and 10.23% respectively; the sensitivity, specificity, accuracy, false positive rate, and false negative rate of TCD in the diagnosis of collateral opening of internal and external carotid artery were 88.16%, 92.93%, 90.86%, 7.07% and 11.84% respectively. The opening rate of collateral circulation in the patients with severe stenosis or occlusion was higher than that in patients with mild to moderate stenosis, while that in the patients with mild to moderate stenosis was higher than that in the patients with severe stenosis or occlusion (χ2=9.526, P=0.002). Conclusion TCD has high clinical application value in the evaluation ofcollateral circulation of extracranial internal carotid artery lesions. It can be used as an important method in the diagnosis of internal carotid artery, which is worthy of promotion and application.