摘要
目的探讨颈部血管超声(CDU)与高分辨率磁共振成像(HRMRI)评估单侧颅外段椎动脉夹层(VAD)的一致性。方法连续性回顾纳入2017年1月—2023年3月在苏州大学附一院卒中中心就诊,因突发颈部或后枕部疼痛、有颈部按摩史、出现神经功能障碍等临床疑似颈部动脉夹层的患者132例,同期行CDU与三维HRMRI检查,并以三维HRMRI检查结果作为参考标准,采用Kappa一致性检验分析CDU评估单侧颅外段VAD的敏感度、特异度及准确性;通过CDU与HRMRI分别观察并记录颅外段VAD夹层病变部位及影像征象,即内膜撕裂征、壁内血肿、双腔征、腔内血栓、夹层动脉瘤、管腔不规则,采用北美症状性颈动脉内膜切除试验(NASCET)方法计算血管狭窄程度,并将二者检查结果进行Kappa一致性分析。结果(1)一致性分析:CDU评估单侧颅外段VAD的阳性率为93.2%(123/132),HRMRI为93.9%(124/132),二者一致性很强(Kappa为0.87);CDU检查颅外段VAD的敏感度为99.2%,特异度为87.5%,准确率为86.7%。(2)CDU与HRMRI影像征象:两者评估双腔征、夹层动脉瘤、管腔不规则、病变部位及血管狭窄程度均一致性很强,Kappa值分别1.00、0.85、0.88、0.94、0.89;两者评估壁内血肿及腔内血栓一致性较强,Kappa值分别为0.79及0.80,且HRMRI观察强化壁内血肿为17.7%;两者评估内膜撕裂征一致性中等,Kappa值为0.58。结论CDU能够有效地评估颅外段VAD的不同影像征象和血管狭窄程度,为颅外段VAD早期诊治及定期随访提供可靠的影像学依据。
Objective To investigate the agreement between cervical vascular Doppler ultrasound(CDU)and high-resolution magnetic resonance imaging(HRMRI)for the assessment of unilateral extracranial vertebral artery dissection(VAD).Methods We retrospectively included 132 consecutive patients who presented to the Stroke Center of The First Affiliated Hospital of Soochow University from January 2017 to March 2023 due to clinically suspected cervical artery dissection with sudden pain in the neck and posterior occipital region,neurological dysfunction,and a history of neck massage.They underwent CDU and three dimen-sional(3D)HRMRI at the same time.The sensitivity,specificity,and accuracy of CDU for assessing unilateral extracranial VAD were analyzed using the Kappa agreement test with 3D HRMRI findings as the reference standard.Furthermore,we examined CDU and HRMRI images for the location and specific signs(including intimal tear,intramural hematoma,double-lumen sign,intralumi-nal thrombus,dissecting aneurysm,and irregular lumen)of extracranial VAD.The degree of vascular stenosis was calculated by the North American Symptomatic Carotid Endarterectomy Test(NASCET).The agreement of the two examinations was analyzed us-ing the Kappa test.Results The positive rates of unilateral extracranial VAD assessed by CDU and by HRMRI were 93.2%(123/132)and 93.9%(124/132),respectively,indicating excellent agreement between the two examinations(Kappa value,0.87).For CDU detecting extracranial VAD,the sensitivity was 99.2%,the specificity was 87.5%,and the accuracy was 86.7%.CDU and HRMRI showed excellent agreement in assessing the double-lumen sign,dissecting aneurysm,irregular lumen,lesion location,and the degree of vascular stenosis,with the Kappa values being 1.00,0.85,0.88,0.94,and 0.89,respectively;the two methods showed good agreement for intramural hematoma and intraluminal thrombus,with the Kappa values being 0.79 and 0.80,respec-tively,and the positive rate of enhanced intramural hematoma detected by HRMRI was 17.7%;the agreement for
作者
颜燕红
惠品晶
陆紫微
张白
丁亚芳
王润川
胡春洪
方琪
YAN Yanhong;HUI Pinjing;LU Ziwei(Department of Cer-vical and Cerebrovascular Ultrasound,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《中风与神经疾病杂志》
CAS
2023年第10期877-882,共6页
Journal of Apoplexy and Nervous Diseases
基金
苏州市民生科技项目(SS202061)
苏州大学技术合作项目(H211064)。
关键词
颅外段
椎动脉夹层
超声
高分辨率磁共振成像
影像征象
Extracranial
Vertebral artery dis-section
Ultrasound
High-resolution magnetic reso-nance imaging
Imaging sign
