Yurdakul Mehmet, Tola Muharrem, Ozdemir Ensar, Işiksalan Ozbülbül Nilgün, Cumhur Turhan
Yüksek Ihtisas Hastanesi, Radyoloji Bölümü, Ankara, Turkey.
Tani Girisim Radyol. 2004 Jun;10(2):167-72.
The traditional categorizations of color Doppler ultrasonography (CDUS) used for grading internal carotid artery stenosis are not consistent with the multicenter controlled randomized studies of carotid artery endarterectomy. The purpose of this study was to determine duplex Doppler threshold values specific to our center for classification of critical internal carotid artery stenosis which is determined according to the results obtained from multi-center clinical studies.
CDUS and digital subtraction angiography examinations were performed in 147 patients who were considered suitable for carotid endarterectomy. Using the values of peak systolic velocity (PSV), end diastolic velocity and peak systolic velocity ratio (PSV ICA/CCA), the optimum duplex Doppler threshold values were determined for internal artery carotid stenoses by ROC (receiver operating characteristics) analysis.
The most accurate threshold levels for detection of ICA stenoses were found to be a PSV 133 cm/s for 50-99% stenosis, PSV ICA/CCA 2.6 for 60-99% stenosis and PSV ICA/CCA 3.6 for 70-99% stenosis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy estimated using optimal duplex criteria for identification of ICA stenoses were 88%, 85% 78%, 91%, 86% for 50-69%, 94%, 87%, 71%, 98%, 89% for 60-99% stenosis, 92%, 92%, 65%, 99%, 92% for 70-99% stenosis, respectively.
The duplex criteria established in our center have high accuracy. Every center should establish its own duplex criteria for the diagnosis of carotid artery stenosis.
用于评估颈内动脉狭窄程度的传统彩色多普勒超声（CDUS）分类方法与颈动脉内膜切除术的多中心对照随机研究结果不一致。本研究的目的是根据多中心临床研究结果，确定本中心用于诊断严重颈内动脉狭窄的双功多普勒阈值。
对147例被认为适合进行颈动脉内膜切除术的患者进行了CDUS和数字减影血管造影检查。利用收缩期峰值流速（PSV）、舒张末期流速和收缩期峰值流速比值（PSV ICA/CCA）的值，通过ROC（受试者工作特征）分析确定颈内动脉狭窄的最佳双功多普勒阈值。
检测颈内动脉狭窄最准确的阈值水平为：50 - 99%狭窄时PSV为133 cm/s，60 - 99%狭窄时PSV ICA/CCA为2.6，70 - 99%狭窄时PSV ICA/CCA为3.6。使用最佳双功标准识别颈内动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为：50 - 69%狭窄时为88%、85%、78%、91%、86%；60 - 99%狭窄时为94%、87%、71%、98%、89%；70 - 99%狭窄时为92%、92%、65%、99%、92%。
本中心建立的双功标准具有较高的准确性。每个中心都应建立自己的双功标准用于诊断颈动脉狭窄。
