作者单位:100053北京,首都医科大学宣武医院超声诊断科(华扬、刘蓓蓓、凌晨、段春、刘强),介入放射诊断治疗中心(缪中荣、李慎茂、凌锋)·影像诊断研究·超声检查对颈动脉狭窄50%～69%和70%～99%诊断准确性的评估华扬刘蓓蓓凌晨段春刘强缪中荣李慎茂凌锋【摘要】目的探讨彩色多普勒血流显像(CDFI)诊断中国人颈动脉狭窄性病变的血流动力学参数标准及准确性。方法应用CDFI检测416例颈动脉狭窄性病变患者的颈总动脉远段、颈内动脉狭窄段、狭窄远段血管(共832支)的收缩期峰值流速(PSVCCA、PSVICA、PSVDIS)和颈内动脉狭窄段、狭窄远段血管舒张期末流速(EDVICA、EDVDIS),以DSA检查结果为标准计算PSVICA/PSVCCA、PSVICA/PSVDIS、EDVICA/EDVDIS及受试者特征(ROC)曲线下面积,比较上述各参数在不同取值下的敏感性、特异性及准确性,并与以往文献中推荐的CDFI诊断标准进行比较。结果①诊断颈动脉50%～69%狭窄的参数标准依次为PSVICA≥155cm/s、EDVICA≥60cm/s、PSVICA/PSVCCA≥210、PSVICA/PSVDIS≥116。70%～99%狭窄的参数选择是PSVICA≥220cm/s、EDVICA≥100cm/s、PSVICA/PSVCCA≥315、PSVICA/PSVDIS≥315。②联合采用PSVICA、EDVICA、PSVICA/PSVDIS或PSVICA、EDVICA、PSVICA/PSVCCA参数标准,CDFI诊断颈动脉狭窄50%～69%和70%～99%与DSA的符合率,分别为9515%、9219%和9614%、9319%。③PSVICA/PSVDIS比值对于颈动脉70%～99%狭窄病变的准确率(9111%)高于PSVICA/PSVCCA(9018%)。结论PSVICA、EDVICA、PSVICA/PSVDIS、PSVICA/PSVCCA是评估颈动脉狭窄程度准确的多普勒血流动力学参数。各参数联合可以进一步提高诊断准确率。【关键词】颈动脉狭窄;彩色多普勒超声;诊断;参考标准【中图分类号】R44511;R54314【文献标识码】AAccurateassessmentofthediagnosisbetween50269%and70299%carotidstenoseswithultrasono2graphyHUAYang,LIUBei2bei,LINGChen,DUANChun,LIUQiang,MIAOZhong2rong,LIShen2mao,LINGFeng.DepartmentofUltrasonicDiagnosis,XuanwuHospital,theCapitalUniversityofMedicalSciences,Beijing100053,ChinaAbstract:ObjectiveTodiscusshemodynamicparametercriteriaandtheiraccuracyindiagnosingcarotidstenoticlesionsinpatientswithcolorDopplerflowimaging(CDFI).MethodsThepeaksystol2icvelocity(PSVCCA,PSVIC,PSVDIS)andend2diastolicflowvelocity(EDVICA,EDVDIS)in416patientswithcarotidstenoticlesionondistalcommoncarotidarteries,stenoticsegmentsoftheinternalcarotidarter2y,andstenoticdistalarteries(832arteries)weredetectedbyusingCDFI.Usingtheresultsofdigitalsub2tractionangiography(DSA)ascriteria,PSVICA/PSVCCA,PSVICA/PSVDIS,EDVICA/EDVDISandreceiver2operatorcharacteristic(ROC)areaunderthecurvewerecalculated.Thesensitivity,specificityandoverallaccuracyoftheaboveparametersunderthedifferentvalueswerecompared,andtheywerealsocomparedwiththerecommendedCDFIdiagnosticcriteriainthepreviousliteratures.ResultsTheparametercrite2riafordiagnosing50%269%stenoseswereinorderofPSVICA≥155cm/s,EDVICA≥60cm/s,PSVICA/PSVCCA≥210,andPSVICA/PSVDIS≥116;theparameterselectionof70%299%stenoseswerePSVICA≥220cm/s,EDVICA≥100cm/s,PSVICA/PSVCCA≥315,andPSVICA/PSVDIS≥315.ThecombinationofPSVICA,EDVICA,PSVICA/PSVCCAorPSVICA,EDVICA,andPSVICA/PSVDISimprovedthediagnosticaccord2ancerateof50%269%or70%299%carotidstenosesandDSA;theywere9515%,9219%,9614%,and9319%,respectively.Theaccuracy(9111%)ofPSVICA/PSVDISoddsfor70%299%carotidstenoticle2sionswashigherthanPSVICA/PSVCCA.ConclusionPSVICA,EDVICA,PSVICA/PSVDIS,andPSVICA/·112·中国脑血管病杂志2006年5月18日第3卷第5期ChinJCerebrovascDis,May118,2006,Vol13,No15PSVCCAaretheaccuratehemodynamicparametersinassessingtheseverityofcarotidstenosis,andthecom2binationoftheseparametersmayimprovetheaccuracyofdiagnosis.Keywords:Carotidstenosis;ColorDopplerflowi...
