测量颈动脉狭窄——尸检血管造影与平面测量金标准的比较。

Measuring carotid artery stenosis--comparison of postmortem arteriograms with the planimetric gold standard.

作者信息

Schulte-Altedorneburg Gernot, Droste Dirk W, Kollár Józef, Beyna Torsten, Felszeghy Szabolcs, Módis László, Hegedüs Csaba, Ringelstein E Bernd, Csiba László

机构信息

Department of Neurology, University of Debrecen, Medical and Health Science Centre, Faculty of Medicine, Debrecen, Hungary.

出版信息

J Neurol. 2005 May;252(5):575-82. doi: 10.1007/s00415-005-0703-5. Epub 2005 Mar 23.

DOI:10.1007/s00415-005-0703-5

PMID:15778910

Abstract

OBJECTIVE

Five different calliper methods for assessing the degree of carotid artery stenosis and visual estimation ("eyeballing") of postmortem carotid arteriograms were compared with the planimetric gold standard of the area reduction at the site of the stenosis.

METHODS

During autopsy 53 carotid specimens were removed in toto from 31 neurological patients. Carotid arteries were ligated and redistended to a physiological degree for standardised three-plane arteriography. Afterwards, the entire specimen was filled with an embedding medium under the same conditions and sectioned. Slices at the site of stenoses were histologically processed. Computerised planimetric analysis of the lumen area reduction was performed and compared with the arteriographic findings. Arteriograms were evaluated by two independent observers by means of linear Common Carotid Artery (CC), the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and squared measurements (NASCET2, ECST2) after applying the pi r2 function. Further, three independent observers performed eyeballing of the degree of stenosis from the postmortem arteriographies.

RESULTS

Planimetry was carried out in 29 internal carotid artery (ICA) and 17 common carotid artery (CCA) stenoses ranging from 8.5 to 100%. The smallest mean differences of the degree of stenosis in % between planimetry and arteriography were -0.5 and 0.6%. The narrowest 95 %-limits of agreement covered a range of +/-24.1 and 26.3% of stenoses, and the highest correlation coefficients were both 0.9 for the CC and ECST2 techniques, respectively. By eyeballing, the degree of stenosis was underestimated by 13.5 to 15.8% on average. The narrowest limits of agreement between two observers for eyeballing covered a range of 35%.

CONCLUSION

Three-plane arteriography has only a moderate accuracy and reproducibility in detecting and measuring carotid artery stenosis independent of the technique of measurement used.

摘要

目的

将五种不同的卡尺测量方法用于评估颈动脉狭窄程度，并将尸检颈动脉造影的视觉估计（“目测”）与狭窄部位面积缩小的平面测量金标准进行比较。

方法

在尸检过程中，从31例神经科患者身上完整取出53个颈动脉标本。结扎颈动脉并将其重新扩张至生理程度，以进行标准化的三平面动脉造影。之后，在相同条件下用包埋介质填充整个标本并切片。对狭窄部位的切片进行组织学处理。对管腔面积缩小进行计算机平面测量分析，并与动脉造影结果进行比较。两名独立观察者通过线性颈总动脉（CC）、欧洲颈动脉外科试验（ECST）和北美症状性颈动脉内膜切除术试验（NASCET）方法，以及应用πr²函数后的平方测量值（NASCET2、ECST2）对动脉造影进行评估。此外，三名独立观察者对尸检动脉造影的狭窄程度进行目测。

结果

对29例颈内动脉（ICA）和17例颈总动脉（CCA）狭窄进行了平面测量，狭窄范围为8.5%至100%。平面测量与动脉造影之间狭窄程度百分比的最小平均差异分别为-0.5%和0.6%。最窄的95%一致性界限涵盖了狭窄范围的+/-24.1%和26.3%，CC和ECST2技术的最高相关系数均为0.9。通过目测，狭窄程度平均被低估了13.5%至15.8%。两名观察者目测之间最窄的一致性界限涵盖了35%的范围。