Rotstein Andrew H, Gibson Robert N, King Paula M
Radiology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Australas Radiol. 2002 Mar;46(1):52-6. doi: 10.1046/j.1440-1673.2001.00994.x.
Doppler ultrasound grading of internal carotid artery (ICA) stenosis using the two parameters of spectral analysis and internal carotid to common carotid artery peak systolic velocity (ICA/CCA PSV) ratio is well established. The improvements in B-Mode ultrasound image quality now make direct ultrasound NASCET-style stenosis measurement possible. We demonstrate that longitudinal B-mode imaging can produce accurate North American Symptomatic Carotid Endarterectomy Trial (NASCET) style measurements which have good correlation with angiographic images. Ultrasound B-mode stenosis measurement provides a third parameter which can be used in conjunction with the two Doppler parameters for the assessment of ICA stenosis. Taking the highest grade of stenosis of the three parameters produces a sensitivity of 100% for the detection of greater than 50% and greater than 80% stenosis with specificity of 66 and 90%, respectively. The performance of satisfactory B-mode imaging against digital subtraction angiography (DSA) was very encouraging. When the B-mode stenosis measurement showed a normal ICA, the positive predictive value (PPV) of the DSA being normal was 94%. When the B-mode stenosis measurement was 35% or less, the PPV of the DSA stenosis being 35% or less was 93%. These excellent results support the use of good quality B-Mode NASCET style stenosis measurement as the initial ultrasound measurement, with Doppler ultrasound only being performed when the B-mode stenosis measurement is greater than 35% or if the B-mode image is unsatisfactory. This approach would save considerable time enabling better utilization of ultrasound resources.
利用频谱分析和颈内动脉与颈总动脉收缩期峰值流速（ICA/CCA PSV）比值这两个参数对颈内动脉（ICA）狭窄进行多普勒超声分级已得到广泛认可。B超图像质量的提高使得直接进行超声NASCET式狭窄测量成为可能。我们证明，纵向B超成像能够产生准确的北美症状性颈动脉内膜切除术试验（NASCET）式测量结果，且与血管造影图像具有良好的相关性。超声B超狭窄测量提供了第三个参数，可与两个多普勒参数一起用于评估ICA狭窄。取这三个参数中最高级别的狭窄，对于检测大于50%和大于80%的狭窄，敏感性分别为100%，特异性分别为66%和90%。令人满意的B超成像与数字减影血管造影（DSA）相比的表现非常令人鼓舞。当B超狭窄测量显示ICA正常时，DSA正常的阳性预测值（PPV）为94%。当B超狭窄测量为35%或更低时，DSA狭窄为35%或更低的PPV为93%。这些出色的结果支持将高质量的B超NASCET式狭窄测量作为初始超声测量方法，仅在B超狭窄测量大于35%或B超图像不满意时才进行多普勒超声检查。这种方法将节省大量时间，使超声资源得到更好的利用。
