超声NASCET指数：一种评估颈内动脉狭窄的新多普勒参数。
Sonographic NASCET index: a new doppler parameter for assessment of internal carotid artery stenosis.
作者信息
Hathout Gasser M, Fink James R, El-Saden Suzie M, Grant Edward G
机构信息
Department of Radiology, University of California at Los Angeles 90073, USA.
出版信息
AJNR Am J Neuroradiol. 2005 Jan;26(1):68-75.
BACKGROUND AND PURPOSE
Established Doppler parameters for carotid stenosis assessment do not reflect North American Symptomatic Carotid Endarterectomy Trial (NASCET)-style methodology. We derived a Doppler parameter, termed sonographic NASCET index (SNI), and hypothesized that the SNI would provide greater angiographic correlation and better accuracy in predicting stenosis of 70% or greater than that of currently used peak systolic velocity (PSV) measurements.
METHODS
Inclusion criteria of angiographically proved carotid stenoses of 40-95% and measured proximal and distal internal carotid artery Doppler PSV values were established. Occlusions and near occlusions were specifically excluded. Doppler and angiographic data meeting the inclusion criteria from 32 carotid bifurcations were identified; actual angiographic stenoses ranged 40-89%. SNI values were calculated for each vessel. PSV and SNI were correlated with angiography by using linear regression analysis. Accuracies of SNI and PSV in predicting stenosis of 70% or greater were compared at two thresholds.
RESULTS
Correlation between SNI and angiography was superior to that between PSV and angiography (r2=0.64 vs 0.38). PSV and SNI values that corresponded to 70% angiographic stenosis were 345 cm/s and 45.5, respectively. Accuracy of PSV of 345 cm/s or greater in predicting stenosis of 70% or greater was 78%, compared with 88% for SNI of 45.5 or greater. The SNI value that corresponded to a PSV threshold of 250 cm/s was 33. Accuracy of PSV of 250 cm/s or greater in predicting stenosis of 70% or greater was 81%, compared with 88% for SNI of 33 or greater.
CONCLUSION
Correlation between SNI and angiography was greater than that between PSV and angiography. Accuracy of SNI in predicting stenosis of 70% or greater was also superior to that of PSV at two thresholds. These results suggest that SNI may be a better predictor of high-grade carotid stenosis than is PSV.
背景与目的
用于评估颈动脉狭窄的既定多普勒参数未反映北美症状性颈动脉内膜切除术试验（NASCET）的方法。我们推导了一个多普勒参数，称为超声NASCET指数（SNI），并假设SNI在预测70%及以上狭窄方面比目前使用的收缩期峰值流速（PSV）测量具有更高的血管造影相关性和更好的准确性。
方法
确定血管造影证实的40% - 95%颈动脉狭窄以及测量的颈内动脉近端和远端多普勒PSV值的纳入标准。特别排除闭塞和近乎闭塞的情况。从32个颈动脉分叉处识别出符合纳入标准的多普勒和血管造影数据；实际血管造影狭窄范围为40% - 89%。计算每个血管的SNI值。通过线性回归分析将PSV和SNI与血管造影进行相关性分析。在两个阈值下比较SNI和PSV预测70%及以上狭窄的准确性。
结果
SNI与血管造影的相关性优于PSV与血管造影的相关性（r2 = 0.64对0.38）。对应于70%血管造影狭窄的PSV和SNI值分别为345 cm/s和45.5。PSV为345 cm/s及以上预测70%及以上狭窄的准确性为78%，而SNI为45.5及以上时为88%。对应于PSV阈值250 cm/s的SNI值为33。PSV为250 cm/s及以上预测70%及以上狭窄的准确性为81%，而SNI为33及以上时为88%。
结论
SNI与血管造影的相关性大于PSV与血管造影的相关性。在两个阈值下，SNI预测70%及以上狭窄的准确性也优于PSV。这些结果表明，与PSV相比，SNI可能是高级别颈动脉狭窄的更好预测指标。
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