颈部-脑部一体化超声评估椎动脉颅内段狭窄的可行性：与计算机断层扫描血管造影和数字减影血管造影的比较
Feasibility of evaluating the stenosis of intracranial segment in the vertebral artery using neck-brain integrated ultrasound: a comparison with computed tomography angiography and digital subtraction angiography.
作者信息
Wang Jianjun, Ma Qianfeng, Yang Zhenxing, Ma Liyuan
机构信息
Department of Ultrasonography, General Hospital of Ningxia Medical University, Yinchuan, China.
Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China.
出版信息
Ann Transl Med. 2020 Sep;8(18):1155. doi: 10.21037/atm-20-5713.
BACKGROUND
Currently, no clear diagnostic indicator of vertebral artery hypoplasia (VAH) or intracranial stenosis exists in clinic. This study aims to study the feasibility of neck-brain integrated ultrasound for evaluating stenosis of the intracranial segment in the vertebral artery by comparing with those of computed tomography angiography (CTA) and digital subtraction angiography (DSA).
METHODS
Clinical data of 138 patients who presented to our hospital with dizziness and headache as the main symptoms between April 2018 and June 2019 were retrospectively analyzed. Patients were divided into observation group and unilateral VAH group. The diagnosing accuracy of ultrasound, CTA, and DAS, the vertebral artery diameter (VAD), blood flow, end diastolic velocity (EDV), peak systolic velocity (PSV) values, resistance indexes (RIs), and difference of RI were compared between the two groups. The sensitivity, specificity and accuracy of ultrasound hemodynamic indicators in assessing stenosis of the intracranial segment of the vertebral artery were calculated.
RESULTS
The accuracy rates of mild stenosis and non-stenosis with neck-brain integrated ultrasound were significantly different from those with CTA and DSA examination (P<0.05). The VAD, blood flow, EDV and PSV values of the affected side in the observation group were lower than those of the VAH side in the unilateral VAH group, while the RI and RI difference value were significantly higher than the unilateral VAH group (P<0.05). When the predicted boundary value was 2.084 mm (VAD), 56.41 mL/min (blood flow), 8.47 cm/s (EDV), 0.743 (RI), and 0.149 (difference of RI), the sensitivity and specificity were (86.43%, 49.45%), (88.67%, 47.42%), (80.47%, 68.71%), (82.71%, 84.66%), and (95.84%, 80.11%), respectively.
CONCLUSIONS
Neck-brain integrated ultrasound is of great value as a noninvasive examination in the diagnosis of stenotic lesions of the internal cervical vertebral artery. VAD, EDV, blood flow, RI, and the difference in RI can be used as indicators to evaluate stenosis of the internal carotid segment of the vertebral artery and provide a reliable basis for the clinical diagnosis of posterior circulation ischemia.
背景
目前临床上尚无明确的椎动脉发育不全（VAH）或颅内狭窄的诊断指标。本研究旨在通过与计算机断层血管造影（CTA）和数字减影血管造影（DSA）比较，探讨颈脑一体化超声评估椎动脉颅内段狭窄的可行性。
方法
回顾性分析2018年4月至2019年6月我院以头晕、头痛为主要症状就诊的138例患者的临床资料。将患者分为观察组和单侧VAH组。比较两组超声、CTA和DAS的诊断准确性、椎动脉内径（VAD）、血流、舒张末期速度（EDV）、收缩期峰值速度（PSV）值、阻力指数（RIs）及RI差值。计算超声血流动力学指标评估椎动脉颅内段狭窄的敏感性、特异性和准确性。
结果
颈脑一体化超声对轻度狭窄和无狭窄的准确率与CTA和DSA检查有显著差异（P<0.05）。观察组患侧的VAD、血流、EDV和PSV值低于单侧VAH组的VAH侧，而RI及RI差值显著高于单侧VAH组（P<0.05）。当预测界值为2.084mm（VAD）、56.41mL/min（血流）、8.47cm/s（EDV）、0.743（RI）和0.149（RI差值）时，敏感性和特异性分别为（86.43%，49.45%）、（88.67%，47.42%）、（80.47%，68.71%）、（82.71%，84.66%）和（95.84%，80.11%）。
结论
颈脑一体化超声作为一种无创检查方法，在诊断颈内椎动脉狭窄病变方面具有重要价值。VAD、EDV、血流、RI及RI差值可作为评估椎动脉颈内段狭窄的指标，为后循环缺血的临床诊断提供可靠依据。
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