经颈动脉血管造影或计算机断层扫描验证颈总动脉狭窄的准确性。

Validating common carotid stenosis by duplex ultrasound with carotid angiogram or computed tomography scan.

机构信息

Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.

Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.

出版信息

J Vasc Surg. 2014 Feb;59(2):435-9. doi: 10.1016/j.jvs.2013.08.030. Epub 2013 Sep 29.

DOI:10.1016/j.jvs.2013.08.030

PMID:24080127

Abstract

BACKGROUND

No consensus exists for duplex ultrasound criteria in the diagnosis of significant common carotid artery (CCA) stenosis. In general, peak systolic velocity (PSV) >150 cm/s with poststenotic turbulence indicates a stenosis >50%. The purpose of our study is to correlate CCA duplex velocities with angiographic findings of significant stenosis >60%.

METHODS

We reviewed the carotid duplex records from 2008 to 2011 looking for patients with isolated CCA stenosis and no ipsilateral internal or contralateral carotid artery disease who received either a carotid angiogram or a computed tomography scan. We identified 25 patients who had significant CCA disease >60%. We also selected 74 controls without known CCA stenosis. We performed receiver operating characteristics analysis to correlate PSV and end-diastolic velocity (EDV) with angiographic stenosis >60%. The degree of stenosis was determined by measuring the luminal stenosis in comparison to the proximal normal CCA diameter.

RESULTS

Most patients had a carotid angiogram (21/25), four only had a computed tomography angiography and four had both. Eighteen patients had history of neck radiation. The CCA PSV ≥250 cm/s had a sensitivity of 98.7% (81.5%-100%) and a specificity of 95.7% (92.0%-99.9%), CCA PSV ≥300 cm/s had a sensitivity of 90.9% (69.4%-98.4%) and a specificity of 98.7% (92.0%-99.9%). The CCA EDV ≥40 cm/s had a sensitivity of 95.5% (95% confidence interval of 75.1-99.8%) and specificity of 98.7% (92.0%-99.9%), EDV ≥60 cm/s had a sensitivity of 100% (75.1%-99.8%) and specificity of 87% (94.1-100%), and EDV ≥70 cm/s had a sensitivity of 86.4% (64.0%-96.4%) and specificity of 100% (94.1%-100%). The presence of both PSV <250 cm/s and EDV <60 cm/s had a 98.7% negative predictive value, and the presence of both PSV ≥250 cm/s and EDV ≥60 cm/s had 100% positive predictive value.

CONCLUSIONS

Establishing CCA duplex criteria to screen patients with significant stenosis is crucial to identify those who will need further imaging modality or treatment. In our laboratory, CCA PSV ≥250 cm/s and EDV ≥60 cm/s are thresholds that can be used to identify significant (>60%) CCA stenosis with a high degree of accuracy.

摘要

背景

目前对于诊断显著颈总动脉（CCA）狭窄的双功能超声标准尚无共识。一般而言，收缩期峰值流速（PSV）>150cm/s 伴狭窄后湍流提示狭窄>50%。本研究旨在探讨CCA 双功能超声流速与>60%狭窄的血管造影发现之间的相关性。

方法

我们回顾了 2008 年至 2011 年的颈动脉双功能超声记录，寻找孤立性 CCA 狭窄且同侧颈内或对侧颈总动脉无疾病的患者，这些患者接受了颈动脉血管造影或计算机断层扫描。我们确定了 25 例 CCA 疾病>60%的患者。我们还选择了 74 名无已知 CCA 狭窄的对照组患者。我们进行了受试者工作特征分析，以将 PSV 和舒张末期速度（EDV）与>60%的血管造影狭窄相关联。狭窄程度通过测量与近端正常 CCA 直径相比的管腔狭窄来确定。

结果

大多数患者接受了颈动脉血管造影（21/25），4 名仅接受了计算机断层血管造影，4 名两者都接受了。18 名患者有颈部放疗史。CCA PSV≥250cm/s 的敏感性为 98.7%（81.5%-100%），特异性为 95.7%（92.0%-99.9%），CCA PSV≥300cm/s 的敏感性为 90.9%（69.4%-98.4%），特异性为 98.7%（92.0%-99.9%）。CCA EDV≥40cm/s 的敏感性为 95.5%（95%置信区间为 75.1%-99.8%），特异性为 98.7%（92.0%-99.9%），EDV≥60cm/s 的敏感性为 100%（75.1%-99.8%），特异性为 87%（94.1%-100%），EDV≥70cm/s 的敏感性为 86.4%（64.0%-96.4%），特异性为 100%（94.1%-100%）。PSV<250cm/s 和 EDV<60cm/s 同时存在的阴性预测值为 98.7%，PSV≥250cm/s 和 EDV≥60cm/s 同时存在的阳性预测值为 100%。