Division of Vascular Surgery, Columbia University, College of Physicians and Surgeons, 161 Ft Washington Ave, HIP 639, New York, NY 10032, USA.
J Vasc Surg. 2011 Oct;54(4):1067-73. doi: 10.1016/j.jvs.2011.03.282.
Digital subtraction angiography (DSA) is the gold standard for diagnosing lower extremity (LE) arterial lesions. However, duplex ultrasound (DUS) is a widely used, safe, and noninvasive method of detecting LE lesions. The purpose of this study was to establish DUS criteria for detecting and grading de novo stenotic lesions in the femoropopliteal arterial segment.
A prospective database was established including all patients who underwent LE endovascular interventions between 2004 and 2009. Patients with de novo stenotic lesions in the femoropopliteal segment were selected. DUS and DSA data pairs ≤30 days apart were analyzed. Peak systolic velocity (PSV; cm/s), velocity ratio (Vr), and DSA stenosis were noted. Linear regression and receiver operator characteristic (ROC) curves were used.
Two hundred seventy-five lesions in 200 patients were analyzed. Indications were claudication (50.5%), rest pain (12.5%), and tissue loss (37.0%). Mean time interval between DUS and DSA was 24 days. Both PSV (R = .80, R(2) = .641; P < .001) and Vr (R = .73, R(2) = .546; P < .001) showed strong correlation with the degree of angiographic stenosis. ROC analysis showed that to detect ≥70% stenosis, a PSV of 200 cm/s had 89.2% sensitivity and 89.7% specificity, and a Vr of 2.0 had 88.7% sensitivity and 90.2% specificity. Similarly, to differentiate between <50% and ≥50% stenosis, PSV of 150 cm/s and Vr of 1.5 were highly specific and predictive. Combining PSV 200 cm/s and Vr 2.0 for ≥70% stenosis gave 79.0% sensitivity, 99.0% specificity, 99.0% positive predictive value, and 85.0% negative predictive value.
DUS shows a strong agreement with angiography and has good accuracy in detecting femoropopliteal lesions. We propose DUS criteria of PSV 200 cm/s and Vr 2.0 to differentiate between <70% and ≥70% de novo stenosis in the femoropopliteal arterial segment.
数字减影血管造影（DSA）是诊断下肢（LE）动脉病变的金标准。然而，双功能超声（DUS）是一种广泛应用的、安全的、非侵入性的检测 LE 病变的方法。本研究的目的是建立 DUS 标准，用于检测和分级股腘动脉段新发狭窄病变。
建立了一个包括 2004 年至 2009 年期间接受 LE 血管内介入治疗的所有患者的前瞻性数据库。选择股腘动脉段新发狭窄病变的患者。分析 DUS 和 DSA 数据对，时间间隔不超过 30 天。记录峰值收缩速度（PSV；cm/s）、速度比（Vr）和 DSA 狭窄程度。采用线性回归和受试者工作特征（ROC）曲线。
200 名患者的 275 个病变进行了分析。适应证为跛行（50.5%）、静息痛（12.5%）和组织缺失（37.0%）。DUS 和 DSA 之间的平均时间间隔为 24 天。PSV（R =.80，R²=.641；P<.001）和 Vr（R =.73，R²=.546；P<.001）与血管造影狭窄程度均有很强的相关性。ROC 分析显示，检测≥70%狭窄时，PSV 为 200cm/s 时的敏感性为 89.2%，特异性为 89.7%，Vr 为 2.0 时的敏感性为 88.7%，特异性为 90.2%。同样，为了区分<50%和≥50%狭窄，PSV 为 150cm/s 和 Vr 为 1.5 具有很高的特异性和预测性。PSV 为 200cm/s 和 Vr 为 2.0 联合用于检测≥70%狭窄，其敏感性为 79.0%，特异性为 99.0%，阳性预测值为 99.0%，阴性预测值为 85.0%。
DUS 与血管造影具有很强的一致性，在检测股腘动脉病变方面具有良好的准确性。我们提出了 DUS 标准，PSV 为 200cm/s，Vr 为 2.0，用于区分股腘动脉段新发<70%和≥70%狭窄。
