弥漫性颅内疾病的无创检测
Noninvasive detection of diffuse intracranial disease.
作者信息
Sharma Vijay K, Tsivgoulis Georgios, Lao Annabelle Y, Malkoff Marc D, Alexandrov Andrei V
机构信息
Neurosonology and Stroke Research Program, Barrow Neurological Institute, Phoenix, Arizona, USA.
出版信息
Stroke. 2007 Dec;38(12):3175-81. doi: 10.1161/STROKEAHA.107.490755. Epub 2007 Oct 18.
BACKGROUND AND PURPOSE
Intracranial arterial stenosis increases flow velocities on the upslope of the Spencer's curve of cerebral hemodynamics. However, the velocity can decrease with long and severely narrowed vessels. We assessed the frequency and accuracy for detection of focal and diffuse intracranial stenoses using novel diagnostic criteria that take into account increased resistance to flow with widespread lesions.
METHODS
We evaluated consecutive patients referred to a neurovascular ultrasound laboratory with symptoms of cerebral ischemia. Transcranial Doppler mean flow velocities were classified as normal (30 to 99 cm/s), high and low. Pulsatility index >or=1.2 was considered high. Focal intracranial disease was defined as >or=50% diameter reduction by the Warfarin Aspirin in Symptomatic Intracranial Disease criteria. Diffuse disease was defined as stenoses in multiple intracranial arteries, multiple segments of one artery, or a long (>1 cm) stenosis in one major artery on contrast angiography (CT angiography or digital subtraction angiography) as the gold standard.
RESULTS
One hundred fifty-three patients (96 men, 76% white, age 62+/-15 years) had previous strokes (n=135) or transient ischemic attack (n=18). Transcranial Doppler detection of focal and diffuse intracranial disease had sensitivity 79.4% (95% CI: 65.8% to 93%), specificity 92.4% (95% CI: 87.7% to 97.2%), positive predictive value 75.0% (95% CI: 60.9% to 89.2%), negative predictive value 94.0% (95% CI: 89.7% to 98.3%), and overall accuracy 89.5% (95% CI: 84.5% to 94.4%). After adjustment for stroke risk factors, transcranial Doppler findings of low mean flow velocities and high pulsatility index in a single vessel were independently associated with angiographically demonstrated diffuse single vessel intracranial disease, whereas low mean flow velocities/high pulsatility index in multiple vessels were related to multivessel intracranial disease (OR: 19.7, 95% CI: 4.8 to 81.2, P<0.001).
CONCLUSIONS
Diffuse intracranial disease may have a higher than expected frequency in a select stroke population and can be detected with noninvasive screening.
背景与目的
颅内动脉狭窄会使脑血流动力学Spencer曲线上升段的血流速度增加。然而，对于长段且严重狭窄的血管，血流速度可能会降低。我们使用新的诊断标准评估了检测局灶性和弥漫性颅内狭窄的频率及准确性，该标准考虑了广泛病变时血流阻力增加的情况。
方法
我们对因脑缺血症状转诊至神经血管超声实验室的连续患者进行了评估。经颅多普勒平均血流速度分为正常（30至99厘米/秒）、高和低。搏动指数≥1.2被视为高。根据症状性颅内疾病的华法林阿司匹林标准，局灶性颅内疾病定义为直径减少≥50%。弥漫性疾病定义为多条颅内动脉狭窄、一条动脉的多个节段狭窄或对照血管造影（CT血管造影或数字减影血管造影）显示一条主要动脉存在长（>1厘米）狭窄，以血管造影结果作为金标准。
结果
153例患者（96名男性，76%为白人，年龄62±15岁）曾有中风（n = 135）或短暂性脑缺血发作（n = 18）。经颅多普勒检测局灶性和弥漫性颅内疾病的敏感性为79.4%（95%置信区间：65.8%至93%），特异性为92.4%（95%置信区间：87.7%至97.2%），阳性预测值为75.0%（95%置信区间：60.9%至89.2%），阴性预测值为94.0%（95%置信区间：89.7%至98.3%），总体准确性为89.5%（95%置信区间：84.5%至94.4%）。在调整中风危险因素后，经颅多普勒发现单支血管平均血流速度低且搏动指数高与血管造影显示的弥漫性单支血管颅内疾病独立相关，而多支血管平均血流速度低/搏动指数高与多支血管颅内疾病相关（比值比：19.7，95%置信区间：4.8至81.2，P<0.001）。
结论
在特定的中风人群中，弥漫性颅内疾病的发生率可能高于预期，且可通过无创筛查检测到。
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