颈部血管多普勒超声、数字减影血管造影、磁共振血管成像在颈动脉狭窄检查中的对比研究  

Comparative Study of Carotid Color Doppler Ultrasound, Digital Subtract Angiography, and Magnetic Resonance Angiography in Preoperative Evaluation of Carotid Endarterectomy

作　　者：陈杰[1] 余波[2] 谭晋韵[1] 郭文城 

机构地区：[1]复旦大学附属华山医院普外科,200040 [2]复旦大学附属浦东医院,201314

出　　处：《中国临床神经科学》2016年第2期199-204,共6页Chinese Journal of Clinical Neurosciences

基　　金：上海市科委基础重点项目资助(编号:12jc1408101)

摘　　要：目的对比分析颈部彩色多普勒超声(CDUS)、数字减影血管造影(DSA)以及磁共振血管成像(MRA)在颈动脉狭窄度评估方面的差异。方法回顾性分析81例经DSA诊断为颈动脉狭窄患者的临床资料,将其CDUS和MRA的数据与DSA结果进行比较,评价各种影像学检查在颈动脉血管狭窄及斑块检出中的敏感度、特异度和符合率。结果以狭窄率30%、50%、70%分别为节点,MRA、CDUS与DSA 3种方法检出的敏感度分别为78%、85%、73%,特异度分别为99%、98%、96%,符合率分别为90%、92%、91%,阴性预测率分别为94%、93%、90%,阳性预测率分别为95%、96%、90%,阳性似然比分别为77.8、42.5、18.25。MRA与DSA比较,敏感度分别为65%、89%、79%,特异度分别为95%、96%、98%,准确度分别为85%、92%、93%,阴性预测率分别为94%、95%、93%,阳性预测率分别为90%、93%、94%,阳性似然比分别为13.0、21.5、9.5。结论诊断颈动脉狭窄病变时,MRA特异度高,与DSA检测结果一致性较好;MRA与DSA的一致性较CDUS强。Aim To compare the clinical using of carotid color Doppler ultrasound（CDUS）, digital subtraction angiography（DSA） and magnetic resonance angiography（MRA） in preoperative evaluation of carotid endarterectomy. Methods From 2008 to 2014 in Huashan hospital, 81 cases of carotid artery stenosis disease were retrospectively analyzed. Digital subtraction angiography inspection and cervical blood vessels of color Doppler ultrasound and high-resolution magnetic resonance imaging, and the sensitivity of the results of the three kinds of inspection methods of inspection, specific degrees and accuracy were observed. Results Stenosis rate of 30%, 50%, 70% were chosen as measuring nodes. Using DSA as the golden standard, carotid color Doppler ultrasound was compared to DSA. The sensitivity were 78%, 85%, 73%, the specificity were 99%, 98%,96%, and the rate of accuracy were 90%, 92%, 91%. Its negative predictive value were 94%, 93%, 90%, and the positive predictive rate were 95%, 96%, 90%, the positive likelihood ratio were 77.8, 42.5, 18.25. MRA was compared to DSA, the sensitivity were 82%, 88%, 81%, the specificity were 99%, 98%, 98%, the rate of accuracy were 82%, 92%, 93%, and the negative predictive value were 94%, 95%, 93%, the positive predictive rate were 93%, 93%, 94%, the positive likelihood ratio were 21.8, 12.5, 14.5. The stability of the stenosis was examined, 23 pathological specimens of 17 patients were underwent carotid endarterectomy, in which 15 stenosis were stable and 8 unstable. Compared the preoperative evaluation with the pathological result, DSA had 8 misjudgement, while CDUS had two cases and MRA had only one. Conclusion In diagnosis of carotid arterial stenosis, MRA has a higher degree of specificity and a better consistency with digital subtraction angiography than carotid color Doppler ultrasound.

关 键 词：颈动脉狭窄 超声检查 数字减影血管造影 磁共振血管成像 

分 类 号：R743[医药卫生—神经病学与精神病学]