Legemate D A, Teeuwen C, Hoeneveld H, Eikelboom B C
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Br J Surg. 1991 Aug;78(8):1003-8. doi: 10.1002/bjs.1800780835.
To detect haemodynamically significant lesions in the aortoiliac arteries, invasive tests such as angiography and intra-arterial pressure measurement (IAPM) are considered valuable diagnostic tools. The value of duplex scanning as a direct non-invasive examination technique was prospectively compared with intra-arterial digital subtraction angiography (IADSA) and IAPM at rest, and after the administration of papaverine in 60 patients. Excellent agreement, as assessed by the kappa statistic, was shown between duplex scanning and IADSA (kappa = 0.81). A fair agreement was shown between duplex scanning and IAPM (kappa = 0.63), and between IADSA and IAPM (kappa = 0.63). Duplex scanning and IADSA both missed some less haemodynamically critical lesions if IAPM was considered the 'gold standard'. It is concluded that duplex scanning detects haemodynamically significant lesions as effectively as angiography and so may be considered a new and valuable diagnostic tool. IAPM remains necessary to detect some lesions of borderline haemodynamic significance. However, with future developments, duplex scanning has the potential to replace the need even for IAPM.
为检测主髂动脉血流动力学显著病变，诸如血管造影和动脉内压力测量（IAPM）等侵入性检查被视为有价值的诊断工具。在60例患者中，前瞻性地比较了双功扫描作为一种直接非侵入性检查技术与动脉内数字减影血管造影（IADSA）以及静息状态下和注射罂粟碱后的IAPM的价值。通过kappa统计量评估，双功扫描与IADSA之间显示出极佳的一致性（kappa = 0.81）。双功扫描与IAPM之间以及IADSA与IAPM之间显示出一般的一致性（kappa = 0.63）。如果将IAPM视为“金标准”，双功扫描和IADSA都会漏诊一些血流动力学不太关键的病变。结论是，双功扫描检测血流动力学显著病变的效果与血管造影一样有效，因此可被视为一种新的有价值的诊断工具。检测一些血流动力学意义临界的病变仍需要IAPM。然而，随着未来的发展，双功扫描甚至有可能取代对IAPM的需求。
