椎动脉近端狭窄的彩色多普勒成像评估
Color Doppler imaging evaluation of proximal vertebral artery stenosis.
作者信息
Hua Yang, Meng Xiu-Feng, Jia Ling-Yun, Ling Chen, Miao Zhong-Rong, Ling Feng, Liu Ji-Bin
机构信息
Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
出版信息
AJR Am J Roentgenol. 2009 Nov;193(5):1434-8. doi: 10.2214/AJR.09.2624.
OBJECTIVE
The sonographic diagnostic criteria for vertebral artery stenosis have not been fully investigated. The purpose of this study was to assess hemodynamic parameters at color Doppler imaging and to determine, with digital subtraction angiography as the reference standard, the optimal thresholds for evaluation of proximal vertebral artery stenosis.
MATERIALS AND METHODS
Among 653 patients with symptoms of ischemia of the posterior circulation, 247 subjects with normal arteries or stenosis of the proximal vertebral artery confirmed with digital subtraction angiography were included in the study. Peak systolic velocity at the origin of the vertebral artery (PSV(origin)) and in intervertebral segments of the vertebral artery (PSV(IV)), end-diastolic velocity at the origin and in the intervertebral segments of the vertebral artery, and the diameter of the vascular lumen were measured. The cutoff values for the diagnosis of < 50%, 50-69%, and 70-99% stenosis were determined with receiver operating characteristics analysis.
RESULTS
The optimal cutoff values of hemodynamic parameters in evaluation of stenosis of the proximal vertebral artery for < 50% stenosis were PSV(origin) >or= 85 cm/s, PSV(origin) / PSV(IV) >or= 1.3, and end-diastolic velocity at the origin >or= 27 cm/s; for 50-69% stenosis were PSV(origin) >or= 140 cm/s, PSV(origin) / PSV(IV) >or/= 2.1, and end-diastolic velocity at the origin >or= 35 cm/s; and for 70-99% stenosis were PSV(origin) >or= 210 cm/s, PSV(origin) / PSV(IV) >or= 4.0, and end-diastolic velocity at the origin >or= 50 cm/s. PSV(origin) was the most useful hemodynamic parameter, having accuracy of 94.5%, 96.2%, and 88.7% for the diagnosis of < 50%, 50-69%, and 70-99% stenosis.
CONCLUSION
Color Doppler imaging is a reliable method for evaluation of vertebral artery stenosis. The results derived from this study can be used as a reference for establishing sonographic criteria for proximal vertebral artery stenosis.
目的
椎动脉狭窄的超声诊断标准尚未得到充分研究。本研究的目的是评估彩色多普勒成像时的血流动力学参数，并以数字减影血管造影为参考标准，确定评估椎动脉近端狭窄的最佳阈值。
材料与方法
在653例有后循环缺血症状的患者中，纳入247例经数字减影血管造影证实动脉正常或椎动脉近端狭窄的受试者。测量椎动脉起始处的收缩期峰值流速（PSV(起始)）、椎动脉椎间段的收缩期峰值流速（PSV(IV)）、椎动脉起始处和椎间段的舒张末期流速以及血管腔直径。采用受试者操作特征分析确定诊断<50%、50 - 69%和70 - 99%狭窄的临界值。
结果
评估椎动脉近端狭窄时，<50%狭窄的血流动力学参数最佳临界值为PSV(起始)≥85 cm/s、PSV(起始)/PSV(IV)≥1.3且起始处舒张末期流速≥27 cm/s；50 - 69%狭窄为PSV(起始)≥140 cm/s、PSV(起始)/PSV(IV)≥2.1且起始处舒张末期流速≥35 cm/s；70 - 99%狭窄为PSV(起始)≥210 cm/s、PSV(起始)/PSV(IV)≥4.0且起始处舒张末期流速≥50 cm/s。PSV(起始)是最有用的血流动力学参数，诊断<50%、50 - 69%和70 - 99%狭窄的准确率分别为94.5%、96.2%和88.7%。
结论
彩色多普勒成像术是评估椎动脉狭窄的可靠方法。本研究结果可作为建立椎动脉近端狭窄超声诊断标准的参考。
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