大脑后动脉血流动力学彩色超声检查对胚胎型大脑后动脉患者脑梗死发生的风险评估价值  

Assessment value of hemodynamic color ultrasound examination on posterior cerebral artery for occurringcerebral infarction in patients with FTP cerebral artery

作　　者：许祥丽 朱芳芳 郭春丰 张琦 谭大宇 韩柳 Xu Xiangli;Zhu Fangfang;Guo Chunfeng;Zhang Qi;Tan Dayu;Han Liu(Department of Ultrasound,The Second Hospital of Harbin City,Harbin 150056,China;Department of MRI,The Second Hospital of Harbin City,Harbin 150056,China)

机构地区：[1]哈尔滨市第二医院超声科,哈尔滨150056 [2]哈尔滨市第二医院核磁共振室,哈尔滨150056

出　　处：《中国医学装备》2024年第10期74-80,共7页China Medical Equipment

基　　金：黑龙江省卫生健康委科研课题(20210909020226)。

摘　　要：目的:分析经颅彩色多普勒超声(TCCD)检测大脑后动脉(PCA)血流动力学对胚胎型大脑后动脉(FTP)患者脑梗死发生的风险评估价值。方法:回顾性选取2020年1月至2023年12月哈尔滨市第二医院神经内科收治的300例疑似脑血管病患者,其中7例为脑出血(不合并脑梗死)患者未纳入研究。根据其临床表现及影像学检查结果将293例患者分为短暂性脑缺血发作(TIA)(176例)和急性缺血性脑卒中(AIS)(117例),对比TCCD检查与核磁共振血管造影(MRA)在FTP检出上的差异,对比TIA、前循环梗死、后循环梗死及腔隙性脑梗死在PCA血流动力学上的差异,对比TIA、前循环梗死、后循环梗死、腔隙性脑梗死合并FTP患者的比例,对比双侧与单侧cFTP、双侧与单侧pFTP和nFTP后循环梗死患者PCA的血流动力学情况;对比双侧与单侧cFTP、双侧与单侧pFTP和nFTP的TIA患者短期内发生AIS的比例;采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估PCA血流动力学异常对合并和(或)不合并FTP的TIA患者发生短期内AIS的预测价值。结果:MRA发现293例患者中有89例患者合并FTP,其中14例为双侧cFTP(占15.73%),25例为单侧cFTP(占28.09%),8例为双侧pFTP(占8.99%),42例为单侧pFTP(占47.19%)。经TCCD检测发现,293例患者中共计有89例合并FTP,其中16例为双侧cFTP(占17.98%),23例为单侧cFTP(占25.84%),8例为双侧pFTP(占8.99%),42例为单侧pFTP(占47.19%)。TCCD与MRA检测具有良好的一致性(Kappa=0.899)。TCCD下后循环梗死患者PCA的收缩期血流速度(Vp)、平均血流速(Vm)、舒张期血流速度(Vd)和阻力指数(RI)明显高于TIA、前循环梗死、腔隙性脑梗死患者,差异有统计学意义(F=15.392、9.032,P<0.05)。后循环梗死患者中更容易出现双侧cFTP。双侧cFTP患者的Vp、Vm及Vd均明显高于双侧pFTP、单侧pFTP及无FTP的患者,差异有统计学意义(F=14.932、8.884、6.054,P<0.05)。双侧cFTP的TIA患者发生AIS的比例明显高于单侧Objective:To analyze assessment value of the hemodynamics of posterior cerebral artery(PCA)detected by transcranial color-coded Doppler(TCCD)ultrasound for occurring cerebral infarction in patients with fetal-type posterior cerebral artery(FTP).Methods:A total of 300 patients with suspected cerebrovascular disease admitted to the Department of Neurology of The Second Hospital of Harbin City from January,2020 to December 31,2023 were retrospectively selected.In these patients,7 cases with cerebral hemorrhage(without complication of cerebral infarction)did not be included.According to the clinical manifestations and the results of imaging examination,293 patients were divided into transient ischemic attack(TIA)group(176 cases)and acute ischemic stroke(AIS)group(117 cases).The differences in FTP detection between TCCD examination and magnetic resonance angiography(MRA)were compared.The differences in PCA hemodynamics among TIA,anterior circulation infarction,posterior circulation infarction and lacunar infarction were compared.The proportions of patients with TIA,anterior circulation infarction,posterior circulation infarction and lacunar infarction combined with FTP were also compared,and the PCA hemodynamics of patients with posterior circulation infarction of bilateral cFTP,unilateral cFTP,bilateral pFTP,unilateral pFTP and nFTP were compared.The proportions of patients with transient ischemic attack(TIA)who occurring AIS at bilateral cFTP,unilateral cFTP,bilateral pFTP,unilateral pFTP and nFTP in short term were compared.The receiver operating characteristic(ROC)curve and area under curve(AUC)were used to assess the predictive value of abnormal PCA hemodynamics of TIA patients,who combined with and/or without FTP,occurred AIS in short term.Results:MRA revealed that a total of 89 patients combined with FTP in 293 patients,of which 14 cases were bilateral cFTP(accounting for 15.73%),and 25 cases were unilateral cFTP(accounting for 28.09%),and 8 cases were bilateral pFTP(accounting for 8.99%),and 42 cases were unil

关 键 词：经颅彩色多普勒超声(TCCD) 大脑后动脉(PCA) 胚胎型大脑后动脉 脑梗死 血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学]