Fujimoto Shigeru, Toyoda Kazunori, Kishikawa Kazuhiro, Inoue Tooru, Yasumori Kotaro, Ibayashi Setsuro, Iida Mitsuo, Okada Yasushi
Department of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Cerebrovasc Dis. 2006;22(2-3):170-6. doi: 10.1159/000093451. Epub 2006 May 19.
To investigate the accuracy of conventional carotid ultrasonography (CCU) combined with transoral carotid ultrasonography (TOCU) for distinguishing pseudo-occlusion from total occlusion of the internal carotid artery (ICA).
This study included 95 patients who were suspected of having an occlusion of the ICA on magnetic resonance angiography (MRA) and underwent both CCU and conventional digital subtraction angiography (DSA) in order to confirm the diagnosis. TOCU was also performed to observe the cervical portion of the ICA distal to the stenosis. We compared the ultrasonographic findings with the DSA findings.
Twelve of the 95 patients were defined as having an ICA pseudo-occlusion on DSA. On B-mode images with CCU color Doppler, slight residual flow signals in the ICA lumen were shown in 20 patients. Among them, 2 patients had a pulsed Doppler waveform of the distal ICA occlusion pattern. Among the remaining 18 patients, 4 had a pulsed Doppler waveform of the to and fro flow pattern, and 14 had a weak antegrade flow pattern in the ICA lumen. The conventional ultrasonographic method showed 100% sensitivity with 93% specificity for diagnosing an ICA pseudo-occlusion. The addition of TOCU findings increased the specificity to 98%. In 2 patients, who were overdiagnosed as having an ICA pseudo-occlusion even using TOCU, DSA revealed an occlusion of the ICA distal to the ophthalmic artery with a severe stenosis of the proximal ICA.
Using conventional and transoral carotid ultrasonography, an ICA pseudo-occlusion can be diagnosed with higher accuracy.
探讨传统颈动脉超声检查（CCU）联合经口颈动脉超声检查（TOCU）区分颈内动脉（ICA）假性闭塞与完全闭塞的准确性。
本研究纳入95例在磁共振血管造影（MRA）上疑似ICA闭塞并接受CCU及传统数字减影血管造影（DSA）以确诊的患者。还进行了TOCU以观察狭窄远端ICA的颈部部分。我们将超声检查结果与DSA结果进行了比较。
95例患者中有12例在DSA上被定义为ICA假性闭塞。在CCU彩色多普勒B模式图像上，20例患者的ICA管腔内显示有轻微残余血流信号。其中，2例患者的ICA远端呈现闭塞型脉冲多普勒波形。在其余18例患者中，4例呈现来回血流型脉冲多普勒波形，14例在ICA管腔内呈现微弱的正向血流型。传统超声检查方法诊断ICA假性闭塞的敏感性为100%，特异性为93%。加入TOCU检查结果后，特异性提高到98%。在2例即使使用TOCU仍被过度诊断为ICA假性闭塞的患者中，DSA显示眼动脉远端的ICA闭塞，近端ICA严重狭窄。
使用传统及经口颈动脉超声检查，可更准确地诊断ICA假性闭塞。
