超声在椎动脉起源异常中的诊断价值研究  

The Diagnostic Value of Ultrasound in Anomalous Origin of Vertebral Artery

作　　者：裴思蝶 熊华花[1] 邹霞[1] 赵莹莹 邓水平[1] 李俊泉 温作苗 Pei Sidie;Xiong Huahua;Zou Xia;Zhao Yingying;Deng Shuiping;Li Junquan;Wen Zuomiao(Department of Ultrasond,Shenzhen Second People’s Hospital,Shenzhen,Guangdong 518035,China)

机构地区：[1]深圳市第二人民医院超声医学科,广东省深圳市518035

出　　处：《中国超声医学杂志》2024年第4期390-393,共4页Chinese Journal of Ultrasound in Medicine

基　　金：深圳市第二人民医院临床研究基金广东省高水平医院建设项目(No.20213357016);广东省自然科学基金(No.2020B1515120061);深圳市重点医学学科建设基金(No.SZXK052)。

摘　　要：目的研究利用椎动脉起源异常容易同时合并走行变异的特点,提高超声诊断椎动脉起源异常的准确度。方法选取就诊并进行脑卒中颈部血管超声检查和头颈部CT血管造影(CTA)的1759例患者,超声观察椎动脉管径、走行路径、开口处,经超声明确诊断和/或CTA诊断椎动脉起源异常的患者89例,分析椎动脉起源异常、起源异常合并走行变异的发病率,以头颈部CTA为金标准,分析超声检查对椎动脉起源异常的诊断效能。结果1759例患者中椎动脉起源异常者89例,总体发病率为5.1%(89/1759),其中左侧椎动脉异常起源于主动脉弓75例,占椎动脉起源异常的84.3%(75/89);左侧椎动脉与左侧锁骨下动脉共干起源于主动脉弓10例;左侧椎动脉异常起源于左侧颈总动脉1例;右侧椎动脉异常起源于右侧颈总动脉2例,并同时伴有右侧锁骨下动脉迷走、头臂干缺失。双侧椎动脉起源异常1例。89例椎动脉起源异常同时合并走行变异者69例,占77.5%(69/89),其中75例左侧椎动脉异常起源主动脉弓合并走行变异者66例,占88%(66/75)。椎动脉起源异常同时合并走行变异、发育不良者22例,占24.7%(22/89)。椎动脉起源异常的89例患者中,超声明确诊断为起源异常者50例,漏诊39例,超声诊断椎动脉起源异常的诊断符合率为53.2%,Kappa值为0.682,结果表明超声检查与CTA检查的诊断一致性一般。结论超声可以简便无创地显示椎动脉走行、管径、开口处,联合线阵、凸阵探头实时观察血流动力学情况,可以利用左侧椎动脉起源异常往往合并走行变异的特点,通过较容易诊断的走行变异,进一步仔细追踪椎动脉开口处,提高超声诊断左侧椎动脉异常起源的准确度,减少椎动脉开口处病变、锁骨下动脉起始段狭窄闭塞性病变的漏诊。Objective To explore the characteristics of anomalous origin of vertebral artery that often coexist with course variations,aiming to enhance the diagnostic accuracy of ultrasound in identifying vertebral artery course variations.Methods 1759 patients were selected who underwent stroke cervical vascular ultrasound examinations and Computed Tomography Angiography(CTA).The diameter,alignment path,and origin of the vertebral artery were observed by ultrasonography.Among these patients,89 were definitively diagnosed with anomalous origin of vertebral artery either by ultrasound and/or CTA.We analyzed the incidence of anomalous origin of vertebral artery and their co-occurrence with course variations.Using CTA as the gold standard,we evaluated ultrasonography's diagnostic efficacy in detecting anomalous vertebral artery origin.Results In our study of 1759 patients,89 anomalous vertebral artery origin cases were identified,representing an incidence of 5.1%(89/1759).Of these,75 cases(84.3%,75/89)involved the left vertebral artery originating anomalously from the aortic arch.10 cases featured a shared origin of the left vertebral artery with the left subclavian artery from the aortic arch.2 case involved an anomalous origin of the left vertebral artery from the left common carotid artery.1 cases were identified where the right vertebral artery originated anomalously from the right common carotid artery,associated with aberrant right subclavian arteries and the absence of the brachiocephalic trunk.A rare case presented with bilateral anomalous vertebral artery origin.Among the 89 patients with anomalous origins,69 cases(77.5%,69/89)also demonstrated course variations,with 66 of the 75 aortic arch cases(88%,66/75)showing concurrent course variations.Notably,22 cases(24.7%,22/89)involved anomalous origins accompanied by both course variations and dysplasia.In terms of diagnostic accuracy,ultrasound correctly identified anomalous origins in 50 of the 89 cases,missing 39 cases.The compliance rate of ultrasound in diagnosing an

关 键 词：超声 CT血管造影 椎动脉起源异常 走行变异 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]