摘要
目的基于多模式影像对比研究颈部动脉超声(CDU)、CT血管成像(CTA)与数字减影血管造影(DSA)诊断锁骨下动脉狭窄的一致性,以DSA为金标准,旨在寻找锁骨下动脉不同狭窄程度的血流动力学参数。方法回顾性连续纳入2018年1月―2021年12月于苏州大学附属第一医院卒中中心就诊的患者179例,1周内均行CDU、主动脉弓上CT血管造影(CTA)及数字减影血管造影(DSA)检查,至少一项检查提示锁骨下动脉狭窄。分析179例患者双侧锁骨下动脉的狭窄程度。以DSA诊断为金标准评估CDU及CTA诊断锁骨下动脉狭窄程度,分别对CDU及CTA进行狭窄程度的Kappa一致性分析。以DSA为金标准进行狭窄程度分级,采用ROC曲线分析,确定轻度狭窄(<50%)、中度狭窄(50%~69%)和重度狭窄(70%~99%)的血流速度(PSV,EDV)以及血流速度比值(PSVOR/PSVDIS)的最佳截断值。结果(1)Kappa一致性分析:CTA与DSA有较高的一致性(κ=0.777),CDU与DSA有很好的一致性(κ=0.813);(2)以DSA为标准:CDU诊断锁骨下动脉狭窄段的收缩期峰值流速(PSV)、舒张期末流速(EDV)以及狭窄段与狭窄远段收缩期峰值流速比值(PSVOR/PSVDIS)分别为:轻度狭窄:PSV<252 cm/s,EDV<21 cm/s,PSVOR/PSVDIS<1.9;中度狭窄:252 cm/s≤PSV<339 cm/s,21 cm/s≤EDV<39 cm/s,1.9≤PSVOR/PSVDIS<4.0;重度狭窄:PSV≥339 cm/s,EDV≥39 cm/s,PSVOR/PSVDIS≥4.0。结论CDU能够无创、实时动态评估锁骨下动脉狭窄程度并分析血流动力学改变,为临床精准治疗提供分层管理依据。
Objective To investigate the consistency of carotid Doppler ultrasonography(CDU),computed tomogra-phy angiography(CTA),and digital subtraction angiography(DSA)in the diagnosis of subclavian artery stenosis,as well as the hemodynamic parameters for different degrees of subclavian artery stenosis with DSA as the gold standard.Methods A retrospective analysis was performed for 179 patients who were admitted to Stroke Center of The First Affiliated Hospital of So-ochow University from January 2018 to December 2021.CDU,CTA,and DSA were performed within one week,and at least one examination suggested subclavian artery stenosis.The 179 patients were analyzed in terms of the degree of subclavian ar-tery stenosis at both sides.DSA was used as the gold standard to evaluate the degree of subclavian artery stenosis diagnosed by CDU and CTA,and the Kappa consistency analysis was performed for CDU and CTA in evaluating the degree of stenosis.DSA was used as the gold standard for the classification of stenosis degree,and the ROC curve analysis was used to deter-mine the optimal cut-off values of blood flow velocity[peak systolic velocity(PSV)and end-diastolic velocity(EDV)]and blood flow velocity ratio(PSVOR/PSVDIS)in mild stenosis(<50%),moderate stenosis(50%~69%),and severe stenosis(70%~99%).Results The Kappa consistency analysis showed that CTA had a high consistency with DSA(κ=0.777),and CDU had a good consistency with DSA(κ=0.813).With DSA as the standard,the cut-off values of PSV,EDV,and PSVOR/PSVDIS based on CDU were PSV<252 cm/s,EDV<21 cm/s,and PSVOR/PSVDIS<1.9 in the diagnosis of mild stenosis,252 cm/s≤PSV<339 cm/s,21 cm/s≤EDV<39 cm/s,and 1.9≤PSVOR/PSVDIS<4.0 in the diagnosis of moderate stenosis,and PSV≥339 cm/s,EDV≥39 cm/s,and PSVOR/PSVDIS≥4.0 in the diagnosis of severe stenosis.Conclusion CDU can evaluate the de-gree of subclavian artery stenosis and hemodynamic changes in a noninvasive,real-time,and dynamic manner and provide a basis for the hierarchical management of clinical precision treatment.
作者
张灵艳
惠品晶
颜燕红
陶青
胡春洪
刘一之
ZHANG Lingyan;HUI Pinjing;YAN Yanhong(Dushuhu Hospital Affiliated to Soochow University,Suzhou 215128,China)
出处
《中风与神经疾病杂志》
CAS
2023年第10期888-895,共8页
Journal of Apoplexy and Nervous Diseases
基金
苏州市民生科技项目(SS202061)。
关键词
血管超声
锁骨下动脉
血流动力学
CT血管造影
数字减影血管造影
Vascular ultrasound
Subclavian artery
Hemodynamics
Computed tomography angiography
Digital subtraction angiography
