[磁共振血管造影与双功超声检查：对血管造影确定的颈内动脉狭窄≥70 - 99%的预测可靠性]
[MR-angiography and duplex-ultrasonography: predictive reliability for angiographically determined internal carotid artery stenosis >/= 70-99%].
作者信息
Wölfle K D, Schnur C, Pfadenhauer K, Bruijnen H, Bohndorf K, Loeprecht H
机构信息
Klinik für Gefäss- und Thoraxchirurgie, Zentralklinikum Augsburg, Germany.
出版信息
Zentralbl Chir. 2002 Feb;127(2):81-8. doi: 10.1055/s-2002-22031.
PURPOSE
A prospective study was undertaken to evaluate whether digital subtraction angiography (DSA) which is still associated with a substantial morbidity can be replaced by less invasive diagnostic modalities such as duplex scanning (DS) and magnetic resonance angiography (MR-A) for the detection of angiographically defined internal carotid artery (ICA) stenosis >/= 70 %.
PATIENTS AND METHODS
A total of 47 patients with suspected severe ICA stenosis underwent examination of their carotid arteries using duplex studies, MR-A and DSA. According to the study protocol, the arteriographic diameter reduction (DR) >/= 70 % which had to be predicted by DS and MR-A was determined following the NASCET criteria.
RESULTS
Stroke rate following DSA amounted to 2.1 %. In 94 carotid arteries studied by DSA 34 times a DR >/= 70 % was found. Using ROC curve for determining optimal discriminant value, duplex-derived peak systolic velocity (PSV) >/= 250 cm/s provided a sensitivity of 94.1 %, a specificity of 80 %, a positive predictive value (PPV) of 72.7 % and a negative predictive value (NPV) of 96 % to characterise an ICA stenosis >/= 70 %. Due to an inadequate PPV, PSV failed to suffice as the sole preoperative diagnostic modality even if different PSV velocity cut points were applied. On the other hand, end diastolic velocity (EDV) >/= 150 cm/s provided a PPV of 100 % thereby identifying 16/34 ICA stenoses >/= 70 % in our study. MR-A showed a sensitivity of 91.2 %, a specificity of 88.3 %, a PPV of 81.6 %, and a NPV of 94.6 % to predict an ICA stenosis >/= 70 %.
CONCLUSION
In our series, both duplex-derived PSV as well as MR-A provided high sensitivity to detect surgically relevant ICA stenosis. However, to select patients for surgery inclusion of EDV proved to be important due to a high PPV and may spare conventional angiography half of patients with stenosis exceeding 70 %.
目的
开展一项前瞻性研究，以评估数字减影血管造影（DSA）这种仍伴有较高发病率的检查方法是否可被侵入性较小的诊断方式（如双功扫描（DS）和磁共振血管造影（MR-A））所取代，用于检测血管造影显示的颈内动脉（ICA）狭窄≥70%。
患者与方法
共有47例疑似严重ICA狭窄的患者接受了颈动脉双功检查、MR-A和DSA检查。根据研究方案，按照北美症状性颈动脉内膜切除术试验（NASCET）标准确定由DS和MR-A预测的血管造影直径缩小（DR）≥70%。
结果
DSA后的卒中率为2.1%。在通过DSA研究的94条颈动脉中，发现34次DR≥70%。使用ROC曲线确定最佳判别值时，双功衍生的收缩期峰值速度（PSV）≥250 cm/s对特征为ICA狭窄≥70%的检测灵敏度为94.1%，特异性为80%，阳性预测值（PPV）为72.7%，阴性预测值（NPV）为96%。由于PPV不足，即使应用不同的PSV速度切点，PSV也不足以作为唯一的术前诊断方式。另一方面，舒张末期速度（EDV）≥150 cm/s的PPV为100%，因此在我们的研究中识别出16/34例ICA狭窄≥70%。MR-A对预测ICA狭窄≥70%的灵敏度为91.2%，特异性为88.3%，PPV为81.6%，NPV为94.6%。
结论
在我们的系列研究中，双功衍生的PSV以及MR-A对检测具有手术相关性的ICA狭窄均具有较高的灵敏度。然而，由于PPV较高，纳入EDV对于选择手术患者很重要，并且可能使一半狭窄超过70%的患者无需进行传统血管造影。
Zotero 插件