Grant Edward G, Benson Carol B, Moneta Gregory L, Alexandrov Andrei V, Baker J Dennis, Bluth Edward I, Carroll Barbara A, Eliasziw Michael, Gocke John, Hertzberg Barbara S, Katanick Sandra, Needleman Laurence, Pellerito John, Polak Joseph F, Rholl Kenneth S, Wooster Douglas L, Zierler R Eugene
Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033, USA.
Radiology. 2003 Nov;229(2):340-6. doi: 10.1148/radiol.2292030516. Epub 2003 Sep 18.
The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: (a) All internal carotid artery (ICA) examinations should be performed with gray-scale, color Doppler, and spectral Doppler US. (b) The degree of stenosis determined at gray-scale and Doppler US should be stratified into the categories of normal (no stenosis), <50% stenosis, 50%-69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. (c) ICA peak systolic velocity (PSV) and presence of plaque on gray-scale and/or color Doppler images are primarily used in diagnosis and grading of ICA stenosis; two additional parameters, ICA-to-common carotid artery PSV ratio and ICA end-diastolic velocity may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. (d) ICA should be diagnosed as (i) normal when ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible; (ii) <50% stenosis when ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible; (iii) 50%-69% stenosis when ICA PSV is 125-230 cm/sec and plaque is visible; (iv) > or =70% stenosis to near occlusion when ICA PSV is greater than 230 cm/sec and visible plaque and lumen narrowing are seen; (v) near occlusion when there is a markedly narrowed lumen at color Doppler US; and (vi) total occlusion when there is no detectable patent lumen at gray-scale US and no flow at spectral, power, and color Doppler US. (e) The final report should discuss velocity measurements and gray-scale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in the above categories. The panel also considered various technical aspects of carotid US and methods for quality assessment and identified several important unanswered questions meriting future research.
超声放射学会召集了血管超声领域的多学科专家小组，就多普勒超声在协助诊断颈动脉狭窄方面达成共识。基于对现有文献的分析和小组成员的经验，该小组的共识声明被认为代表了一个合理的立场。声明的关键要素如下：(a) 所有颈内动脉（ICA）检查均应使用灰阶、彩色多普勒和频谱多普勒超声进行。(b) 通过灰阶和多普勒超声确定的狭窄程度应分为正常（无狭窄）、<50%狭窄、50%-69%狭窄、≥70%狭窄至接近闭塞、接近闭塞和完全闭塞等类别。(c) ICA 收缩期峰值速度（PSV）以及灰阶和/或彩色多普勒图像上斑块的存在主要用于 ICA 狭窄的诊断和分级；当临床或技术因素引起对 ICA PSV 可能无法代表疾病程度的担忧时，也可使用另外两个参数，即 ICA 与颈总动脉 PSV 比值和 ICA 舒张末期速度。(d) ICA 应诊断为：(i) 当 ICA PSV 小于 125 cm/秒且未见斑块或内膜增厚时为正常；(ii) 当 ICA PSV 小于 125 cm/秒且可见斑块或内膜增厚时为<50%狭窄；(iii) 当 ICA PSV 为 125-230 cm/秒且可见斑块时为 50%-69%狭窄；(iv) 当 ICA PSV 大于 230 cm/秒且可见斑块和管腔狭窄时为≥70%狭窄至接近闭塞；(v) 在彩色多普勒超声显示管腔明显狭窄时为接近闭塞；(vi) 在灰阶超声未检测到通畅管腔且频谱、能量和彩色多普勒超声未见血流时为完全闭塞。(e) 最终报告应讨论速度测量以及灰阶和彩色多普勒检查结果。存在研究局限性时应予以注明。结论应说明上述类别中反映的 ICA 狭窄估计程度。该小组还考虑了颈动脉超声的各种技术方面以及质量评估方法，并确定了几个值得未来研究的重要未解决问题。
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