Leonardo Giuseppe, Crescenzi Basilio, Cotrufo Roberto, Tecame Salvatore, De Santo Luca S, Della Corte Alessandro, Fratta Mario, Cotrufo Maurizio
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Division of Cardiovascular Surgery, Naples, Italy.
J Vasc Surg. 2003 Jun;37(6):1240-7. doi: 10.1016/s0741-5214(02)75138-0.
Validity of a method to improve the accuracy of carotid artery duplex scanning was tested in comparison with arteriography.
In 489 patients who had not previously undergone arteriography, 978 carotid arteries were examined with duplex ultrasound scanning. In method A, a linear array 7.5 MHz transducer with pulsed-wave 4.7 MHz Doppler scanning was used. For the diagnosis and grading of carotid stenosis, peak systolic and end-diastolic velocity of the Doppler waves were recorded. Method B consisted of complete ultrasound imaging and color-flow mapping with a convex array 3.5 MHz transducer with pulsed-wave 2.8 MHz Doppler scanning in all patients who had previously undergone method A. Further velocity measurements were performed at the sites of stenosis. The results of methods A and B were compared with data from neurologic assessment and arteriographic studies.
Method B showed significantly higher diagnostic agreement with arteriography than did method A (K 95% confidence interval [CI], 0.87-0.93 vs 0.79-0.85; P <.05), and the number of mistakes in grading stenosis was significantly lower (primarily because of decreased overestimation) in patients with internal carotid kinking (>60 degrees of angulation) (P <.05), distal stenosis (>20 mm from bifurcation) (P <.01), or wide acoustic shadowing (>1 cm) (P <.01) and in those without these conditions (P <.05). Compared with arteriography, diagnostic accuracy with the new method proved higher for carotid stenoses 50% or greater, 60% or greater, 70% or greater, and 80% or greater; no statistically significant difference was found for carotid stenosis 96% or greater or for carotid occlusion. Compared with data from neurologic assessment and arteriography, method B proved more accurate than method A in designating patients for carotid endarterectomy (P =.014).
The new method significantly improved diagnostic reliability of duplex ultrasound scanning, especially in carotid arteries with kinking, distal stenosis, or wide acoustic shadowing (32.2% of all arteries studied). In clinical practice, we suggest additional use of a lower frequency transducer in cases in which these three conditions are found or suspected at first scanning.
通过与动脉造影术对比，测试一种提高颈动脉双功扫描准确性方法的有效性。
对489例未曾接受过动脉造影术的患者的978条颈动脉进行双功超声扫描检查。方法A：使用带有4.7MHz脉冲波多普勒扫描的7.5MHz线性阵列换能器。为诊断和分级颈动脉狭窄，记录多普勒波的收缩期峰值速度和舒张末期速度。方法B：在所有先前接受过方法A检查的患者中，使用带有2.8MHz脉冲波多普勒扫描的3.5MHz凸阵换能器进行完整的超声成像和彩色血流图检查。在狭窄部位进一步进行速度测量。将方法A和方法B的结果与神经学评估和动脉造影研究的数据进行比较。
方法B与动脉造影术的诊断一致性显著高于方法A（K 95%置信区间[CI]，0.87 - 0.93对比0.79 - 0.85；P <.05），并且在颈内动脉扭曲（>60度成角）（P <.05）、远端狭窄（距分叉>20mm）（P <.01）或宽声影（>1cm）（P <.01）的患者以及无这些情况的患者中，狭窄分级的错误数量显著更低（主要是因为高估减少）（P <.05）。与动脉造影术相比，新方法对50%或更高、60%或更高、70%或更高以及80%或更高的颈动脉狭窄的诊断准确性更高；对于96%或更高的颈动脉狭窄或颈动脉闭塞，未发现统计学上的显著差异。与神经学评估和动脉造影的数据相比，在指定患者进行颈动脉内膜切除术方面，方法B比方法A更准确（P =.014）。
新方法显著提高了双功超声扫描的诊断可靠性，尤其是在有扭曲、远端狭窄或宽声影的颈动脉中（占所有研究动脉的32.2%）。在临床实践中，我们建议在初次扫描发现或怀疑存在这三种情况时额外使用低频换能器。
