颈部动脉超声评估椎动脉颅内段重度狭窄或闭塞性病变可行性研究  

Feasibility of carotid artery ultrasound in evaluating severe stenosis or occlusion of intracranial vertebral artery

作　　者：刘天友 胡春峰 贺克平 江汇浪 单奔 LIU Tianyou;HU Chunfeng;HE Keping;JIANG Huilang;SHAN Ben(Department of Imaging,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Ultrasound,the Affiliated Huai′an Hospital of Xuzhou Medical University,Huai′an,Jiangsu 223002;Department of Ultrasound,Huai′an Fifth People′s Hospital,Huai′an,Jiangsu 223002;Department of Publicity,the Affiliated Huai′an Hospital of Xuzhou Medical University;Department of Imaging,the Affiliated Huai′an Hospital of Xuzhou Medical University)

机构地区：[1]徐州医科大学附属医院影像科,江苏徐州221002 [2]徐州医科大学附属淮安医院超声医学科,江苏淮安223002 [3]淮安市第五人民医院超声科,江苏淮安223002 [4]徐州医科大学附属淮安医院宣传处 [5]徐州医科大学附属淮安医院影像科

出　　处：《徐州医科大学学报》2023年第9期674-680,共7页Journal of Xuzhou Medical University

摘　　要：目的探讨颈部动脉超声评估椎动脉颅内段重度狭窄或闭塞性病变的可行性。方法选取2019年1月—2022年12月于徐州医科大学附属淮安医院就诊、单侧椎动脉颅内段重度狭窄或闭塞的患者205例,作为研究组。其中35例舒张期血流信号消失,故选取其余170例进行统计学分析。根据椎动脉椎间段管径,上述患者进一步分为椎间段管径纤细组(90例)及管径正常组(80例)。选取同期就诊于徐州医科大学附属淮安医院,一侧椎动脉生理性纤细且无狭窄的患者90例以及两侧椎动脉管径正常且无狭窄的患者80例作为对照组。所有患者行彩色多普勒超声检查,记录研究组及对照组双侧椎动脉及颈内动脉颅外段管径(D)、收缩期峰值流速(PSV)、舒张期末流速(EDV)、阻力指数(RI),并计算两侧椎动脉以及患侧椎动脉与同侧颈内动脉各参数差值。以CT血管造影(CTA)及数字减影血管造影(DSA)检查结果作为金标准,绘制ROC曲线分析椎动脉颅外段血流动力学参数评估颅内段重度狭窄或闭塞的可行性。结果与对照组相比,研究组PSV和EDV减低,RI升高,差异有统计学意义(P<0.05)。管径纤细组:椎动脉RI≥0.74、两侧椎动脉RI差值≥0.13、椎动脉与颈内动脉RI差值≥0.15,是椎动脉颅内段重度狭窄或闭塞的独立预测因素,3项参数联合应用的ROC曲线下面积为0.995,联合因子最佳临界值为0.674,其诊断椎动脉颅内段重度狭窄或闭塞的敏感度为97.0%,特异度为96.3%,诊断效能进一步提高,差异有统计学意义(P<0.05)。管径正常组:椎动脉RI≥0.74、EDV≤12.05 cm/s、两侧椎动脉RI差值≥0.09、EDV差值≥5.0 cm/s、椎动脉与颈内动脉RI差值≥0.10,是椎动脉颅内段重度狭窄或闭塞的独立预测因素,5项参数联合应用的ROC曲线下面积为0.992,联合因子最佳临界值为0.631,其诊断椎动脉颅内段重度狭窄或闭塞的敏感度为96.4%,特异度为95.6%,诊断效能进一步提�Objective To investigate the feasibility of carotid artery ultrasound in evaluating severe stenosis or occlusion in vertebral artery(VA).Methods A total of 205 patients with severe stenosis or occlusion in unilateral VA intracranial segments who were admitted to the Affiliated Huai′an Hospital of Xuzhou Medical University from January 2019 to December 2022 were enrolled as a research group.Among them,35 cases had no diastolic blood flow signal,so the other 170 cases in the research group were selected for statistical analysis.According to the diameter of the vertebral artery intervertebral segment,the patients were further divided into two groups:a group with thin diameter in the intervertebral segment(n=90)and a group with normal diameter(n=80).Meanwhile,another 90 patients with one vertebral artery physiologically thin without stenosis,and 80 patients with normal diameter without stenosis in both vertebral arteries who were admitted to the Affiliated Huai′an Hospital of Xuzhou Medical University were included as a control group.Color Doppler ultrasonography(CDU)was performed in all the patients.Their diameter(D),peak systolic velocity(PSV),end diastolic velocity(EDV),and resistance index(RI)of the bilateral vertebral and internal carotid arteries in the research and control groups were recorded,and the differences in parameters between the bilateral vertebral and internal carotid arteries were calculated.Using the results of CT angiography(CTA)and Digital subtraction angiography(DSA)as the gold standards,ROC curves were plotted to analyze the feasibility of the hemodynamic parameters of the extracranial segment of the vertebral artery to evaluate the severity of stenosis or occlusion of the intracranial segment.Results Compared with the control group,the research group showed statistical decreases in PSV and EDV,and increases in RI(P<0.05).For the thin diameter group:vertebral artery RI≥0.74,bilateral vertebral artery RI difference≥0.13,and vertebral artery and internal carotid artery RI difference≥0.

关 键 词：颈部动脉超声 椎动脉颅内段 重度狭窄或闭塞 CT血管造影 数字减影血管造影 

分 类 号：R543[医药卫生—心血管疾病]