Dharmasaroja Pornpatr A, Uransilp Nattaphol, Watcharakorn Arvemas, Piyabhan Pritsana
Stroke and Neurodegenerative Diseases Research Unit, Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani, Thailand.
Department of Internal Medicine, Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani, Thailand.
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):778-782. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.014. Epub 2017 Nov 16.
Extracranial carotid stenosis can be diagnosed by velocity criteria of carotid duplex. Whether they are accurately applied to define severity of internal carotid artery (ICA) stenosis in Asian patients needs to be proved. The purpose of this study was to evaluate the accuracy of 2 carotid duplex velocity criteria in defining significant carotid stenosis.
Carotid duplex studies and magnetic resonance angiography were reviewed. Criteria 1 was recommended by the Society of Radiologists in Ultrasound; moderate stenosis (50%-69%): peak systolic velocity (PSV) 125-230 cm/s, diastolic velocity (DV) 40-100 cm/s; severe stenosis (>70%): PSV greater than 230 cm/s, DV greater than 100 cm/s. Criteria 2 used PSV greater than 140 cm/s, DV less than 110 cm/s to define moderate stenosis (50%-75%) and PSV greater than 140 cm/s, DV greater than 110 cm/s for severe stenosis (76%-95%).
A total of 854 ICA segments were reviewed. There was moderate stenosis in 72 ICAs, severe stenosis in 50 ICAs, and occlusion in 78 ICAs. Criteria 2 had slightly lower sensitivity, whereas higher specificity and accuracy than criteria 1 were observed in detecting moderate stenosis (criteria 1: sensitivity 95%, specificity 83%, accuracy 84%; criteria 2: sensitivity 92%, specificity 92%, and accuracy 92%). However, in detection of severe ICA stenosis, no significant difference in sensitivity, specificity, and accuracy was found (criteria 1: sensitivity 82%, specificity 99.57%, accuracy 98%; criteria 2: sensitivity 86%, specificity 99.68%, and accuracy 99%).
In the subgroup of moderate stenosis, the criteria using ICA PSV greater than 140 cm/s had higher specificity and accuracy than the criteria using ICA PSV 125-230 cm/s. However, there was no significant difference in detection of severe stenosis or occlusion of ICA.
颅外颈动脉狭窄可通过颈动脉双功超声的速度标准进行诊断。这些标准是否能准确应用于定义亚洲患者颈内动脉（ICA）狭窄的严重程度尚需证实。本研究的目的是评估两种颈动脉双功超声速度标准在定义显著颈动脉狭窄方面的准确性。
回顾颈动脉双功超声检查和磁共振血管造影。标准1由超声放射学会推荐；中度狭窄（50%-69%）：收缩期峰值速度（PSV）125-230cm/s，舒张期速度（DV）40-100cm/s；重度狭窄（>70%）：PSV大于230cm/s，DV大于100cm/s。标准2使用PSV大于140cm/s，DV小于110cm/s来定义中度狭窄（50%-75%），PSV大于140cm/s，DV大于110cm/s定义重度狭窄（76%-95%）。
共回顾了854个ICA节段。72个ICA存在中度狭窄，50个ICA存在重度狭窄，78个ICA存在闭塞。标准2的敏感性略低，而在检测中度狭窄时，其特异性和准确性高于标准1（标准1：敏感性95%，特异性83%，准确性84%；标准2：敏感性92%，特异性92%，准确性92%）。然而，在检测重度ICA狭窄时，敏感性、特异性和准确性无显著差异（标准1：敏感性82%，特异性99.57%，准确性98%；标准2：敏感性86%，特异性99.68%，准确性99%）。
在中度狭窄亚组中，使用ICA PSV大于140cm/s的标准比使用ICA PSV 125-230cm/s的标准具有更高的特异性和准确性。然而，在检测重度ICA狭窄或闭塞方面无显著差异。
