经颅多普勒速度标准优化诊断颈内动脉狭窄：报告国际社会认可委员会（IAC）血管检测司颈动脉诊断标准委员会。
Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee.
机构信息
Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
出版信息
Vasc Med. 2021 Oct;26(5):515-525. doi: 10.1177/1358863X211011253. Epub 2021 May 19.
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50-69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.
诊断标准以分类内部颈动脉（ICA）狭窄的严重程度在血管实验室之间有所不同。2003 年由超声放射学家协会（SRUCC）提出的基于共识的标准已经得到广泛实施，但尚未得到充分验证。我们进行了一项多中心、回顾性的超声与导管血管造影相关研究，以评估 ICA 狭窄的严重程度。从 2009 年 1 月 1 日至 2015 年 12 月 31 日期间进行的双侧超声检查中提取速度数据，并使用 SRUCC 进行解释。ICA 狭窄的百分比使用北美症状性颈动脉内膜切除术试验（NASCET）方法确定。接受者操作特征分析评估了 SRUCC 参数与血管造影相比的性能。在 448 个 ICA 侧（来自 224 名患者）中，有 299 个 ICA 侧（来自 167 名患者）纳入研究。超声与血管造影之间的一致性为中度（κ=0.42），对中度（50-69%）和重度（≥70%）ICA 病变的狭窄程度均存在高估。ICA 狭窄≥50%的主要 SRUCC 参数为收缩期峰值速度（PSV）≥125cm/sec，未达到适当的敏感性、特异性和准确性的预设阈值（敏感性 97.8%，特异性 64.2%，准确性 74.5%）。通过将 PSV 阈值提高到≥180cm/sec（敏感性 93.3%，特异性 81.6%，准确性 85.2%）或增加 ICA/颈总动脉（CCA）PSV 比值≥2.0 的附加参数（敏感性 94.3%，特异性 84.3%，准确性 87.4%），可提高测试性能。对于 ICA 狭窄≥70%，由于血管造影严重疾病的病例数量较少，因此分析受到限制。与血管造影相比，使用 SRUCC 进行颈动脉双功能超声检查会导致 ICA 狭窄程度的显著高估；建议将用于 SRUCC 的实验室中≥50%ICA 狭窄的 PSV 阈值提高到≥180cm/sec，作为单一参数，或要求 ICA/CCA PSV 比值≥2.0，同时 PSV≥125cm/sec，以提高颈动脉双功能超声检查的准确性。
Zotero 插件