Forjoe T, Asad Rahi M
Manchester Medical School , Manchester , UK.
Regional Vascular Centre, Royal Preston Hospital , Preston , UK.
Ann R Coll Surg Engl. 2019 Mar;101(3):141-149. doi: 10.1308/rcsann.2019.0010. Epub 2019 Feb 15.
We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy.
Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Studies included were published between 1990 and 2018 and focused on practice in the UK, Europe and North America.
The sensitivity and specificity of CTA and CDU are comparable. CDU is safe and readily available in the clinical environment hence its use in the initial preoperative assessment of carotid stenosis. CDU is an adequate imaging modality for determining stenosis greater than 70%; sensitivity and specificity are improved when the criteria for determining greater than 70% stenosis are adjusted. Vascular laboratories opting to use duplex as their sole imaging modality should assess the sensitivity and specificity of their own duplex procedure before altering practice to preoperative single imaging for patients.
The sensitivity and specificity of CTA (90.6% and 93%, respectively) and CDU (92.3% and 89%, respectively) are comparable. Both are dependent on criteria used in vascular laboratories. CDU sensitivity and specificity was improved to 98.7% and 94.1%, respectively, where peak systolic velocity and end diastolic velocity were assessed. Either modality can be used to determine greater than 70% stenosis, although a secondary imaging modality may be required for cases of greater than 50% stenosis.
我们查阅了关于术前计算机断层扫描颈动脉血管造影和/或颈动脉双功超声的文献，以确定它们在评估颈动脉狭窄程度方面各自的敏感性和特异性。我们旨在确定一种成像方式是否能够准确识别出现短暂性脑缺血发作或有脑血管意外症状且需要进行颈动脉内膜切除术的患者的严重狭窄情况。
系统检索MEDLINE、Embase、Cochrane系统评价数据库以及所有循证医学评价库（Cochrane系统评价数据库、美国医师协会杂志俱乐部、疗效评价文摘数据库、Cochrane临床答案、Cochrane对照试验注册库、Cochrane方法学注册库、卫生技术评估和英国国家医疗服务体系经济评价数据库），查找与计算机断层扫描颈动脉血管造影（CTA）和/或颈动脉双功超声（CDU）相关的原始研究。纳入的研究发表于1990年至2018年之间，重点关注英国、欧洲和北美的实践情况。
CTA和CDU的敏感性和特异性相当。CDU安全且在临床环境中易于获得，因此可用于颈动脉狭窄的术前初步评估。CDU是确定狭窄程度大于70%的一种合适的成像方式；当调整确定大于70%狭窄的标准时，敏感性和特异性会提高。选择将双功超声作为其唯一成像方式的血管实验室，在改变对患者的术前单一成像做法之前，应评估其自身双功超声检查的敏感性和特异性。
CTA（分别为90.6%和93%）和CDU（分别为92.3%和89%）的敏感性和特异性相当。两者均取决于血管实验室所使用的标准。在评估收缩期峰值速度和舒张末期速度时，CDU的敏感性和特异性分别提高到了98.7%和94.1%。两种方式均可用于确定狭窄程度大于70%的情况，不过对于狭窄程度大于50%的病例，可能需要采用第二种成像方式。
