经口腔超声检查颈内动脉近段狭窄及闭塞患者颅外远段管腔及血液动力学变化的价值  

Value of transoral carotid ultrasonography in detecting the change of distal extracranial internal carotid artery with stenosis and occlusion in its initial segment

作　　者：罗利红[1] 吴凤林[1] 王宝平[1] 纪丽景[1] 

机构地区：[1]南方医科大学南方医院超声科,广州510515

出　　处：《中华超声影像学杂志》2012年第4期300-304,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨经口腔超声检查颈内动脉（ICA）近段狭窄或闭塞时颅外远段管腔变化的应用价值。方法病变组110例，高频线阵探头扫查ICA近段狭窄≥50％或闭塞；正常对照组32例。高频线阵探头检测颈总动脉（CCA）及ICA近段，经口腔超声检测ICA颅外远段，观察管腔状况、彩色血流表现及频谱形态变化，测量管径、收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）及PSV ICA／PSV CCA值。超声检查结束后2周内完成数字减影血管造影术（DSA）检查，并与超声结果对照。结果病变组经口腔超声扫查成功率为92．7％，正常对照组经口腔超声扫查成功率为93．8％。从正常组～接近闭塞组ICA远段管径、PSV测值逐渐减小，相邻两组间比较差异有统计学意义（P〈0．05），但接近闭塞组与完全闭塞组管径测值相近，差异无统计学意义（P〉0．05）；完全闭塞组80％管腔内可见血栓回声，20％管腔内无血栓，可见有暗淡彩色血流，并录及低速动脉频谱。ICA远段频谱形态在接近闭组均呈“小慢波”或“单峰状”，在狭窄≥70％～接近闭塞组76．7％频谱毛刺或呈“小慢波”状，在狭窄50％～69％时30．8％频谱毛刺，其余频谱形态正常。结论经口腔超声能获得ICA近段狭窄或闭塞时颅外远段管腔及血流变化的信息，与高频线阵探头联合应用可扫查ICA颅外全段，具有一定的临床应用价值。Objective To investigate the value of transoral carotid ultrasonography （TOCU） in detecting the change of distal extracranial internal carotid artery（ICA） with stenosis and occlusion in its initial segmen. Methods One hundred and ten patients with stenosis at least 50% or occlusion in the initial segment of ICA diagnosed by high-frequency linear probe were enrolled as case group,while thirty-two with healthy carotid arteries as control group. Both of the case and control groups were undergone high-frequency linear probe to examine CCA and the initial segment of ICA, and TOCU to observe their lumen transparency, color Doppler flow display and change of Doppler flow spectrum, even measuring the internal diameter, peak systolic velocity （PSV）, end-diastolic velocity（EDV） and PSVlca/PSVcca ratio, respectively. Digital subtraction angiography （ DSA ） were performed within two weeks, then compared with ultrasonography. Results 92.70% patients were performed TOCU examination in case group and 93.8 % in control group. The internal diameter and PSV of the distal extracranial ICA became gradually smaller from control group to near occlusion group, and there were statistical significance between groups （ P 〈0.05）, however,near occlusion group had no statistical significance compared with occlusion group （ P 〉 0.05）. There were 80% arteries having thrombus echo in occlusion group,and the others in this group having no thrombus had gloomy colour flow, even got low-velocity artery spectrum. Doppler flow spectrum of distal extracranial ICA showed characteristics of slow wave or single peak in near occlusion group, and spike shape or slow wave in 76.7% arteries of 70% -near-occlusion stenosis group, but spike shape in 30.8% arteries of 50%-69% stenosis group,and the others were normal. Conclusions TOCU is useful for detecting the changing regularity of distal extracranial ICA with stenosis or occlusion in its initial segment and has the value of clinical application in association with high-frequ

关 键 词：腔内超声检查 颈动脉狭窄 血液动力学现象 

分 类 号：R445.1[医药卫生—影像医学与核医学]