Brouwers Jeroen J W M, Jiang Janey F Y, Feld Robert T, van Doorn Louk P, van Wissen Rob C, van Walderveen Marianne A A, Hamming Jaap F, Schepers Abbey
Department of Vascular Surgery, Leiden University Medical Center, The Netherlands; Department of Surgery, HagaHospital, The Hague, The Netherlands.
Department of Radiology, Leiden University Medical Center, The Netherlands.
Ann Vasc Surg. 2022 Apr;81:202-210. doi: 10.1016/j.avsg.2021.09.056. Epub 2021 Nov 12.
Doppler ultrasonography (DUS) is used as initial measurement to diagnose and classify carotid artery stenosis. Local distorting factors such as vascular calcification can influence the ability to obtain DUS measurements. The DUS derived maximal systolic acceleration (ACCmax) provides a different way to determine the degree of stenosis. While conventional DUS parameters are measured at the stenosis itself, ACCmax is measured distal to the internal carotid artery (ICA) stenosis. The value of ACCmax in ICA stenosis was investigated in this study.
All carotid artery DUS studies of a tertiary academic center were reviewed from October 2007 until December 2017. Every ICA was included once. The ACCmax was compared to conventional DUS parameters: ICA peak systolic velocity (PSV), and PSV ratio (ICA PSV/ CCA PSV). ROC-curve analysis was used to evaluate accuracy of ACCmax, ICA PSV and PSV ratio as compared to CT-angiography (CTA) derived stenosis measurement as reference test.
The study population consisted of 947 carotid arteries and was divided into 3 groups: <50% (710/947), 50-69% (109/947), and ≥70% (128/947). Between these groups ACCmax was significantly different. Strong correlations between ACCmax and ICA PSV (R 0.88) and PSV ratio (R 0.87) were found. In ROC subanalysis, the ACCmax had a sensitivity of 90% and a specificity of 89% to diagnose a ≥70% ICA stenosis, and a sensitivity of 82% and a specificity of 88% to diagnose a ≥50% ICA stenosis. For diagnosing a ≥50% ICA stenosis the area under the curve (AUC) of ACCmax (0.88) was significantly lower than the AUC of PSV ratio (0.94) and ICA PSV (0.94). To diagnose a ≥70% ICA stenosis there were no significant differences in AUC between ACCmax (0.89), PSV ratio (0.93) and ICA PSV (0.94).
ACCmax is an interesting additional DUS measurement in determining the degree of ICA stenosis. ACCmax is measured distal to the stenosis and is not hampered by local distorting factors at the site of the stenosis. ACCmax can accurately diagnose an ICA stenosis, but was somewhat inferior compared to ICA PSV and PSV ratio to diagnose a ≥50% ICA stenosis.
多普勒超声检查（DUS）被用作诊断和分类颈动脉狭窄的初始测量方法。血管钙化等局部扭曲因素会影响获取DUS测量值的能力。DUS得出的最大收缩期加速度（ACCmax）提供了一种不同的确定狭窄程度的方法。传统的DUS参数是在狭窄部位本身测量的，而ACCmax是在内颈动脉（ICA）狭窄远端测量的。本研究调查了ACCmax在ICA狭窄中的价值。
回顾了2007年10月至2017年12月一家三级学术中心的所有颈动脉DUS研究。每条ICA只纳入一次。将ACCmax与传统的DUS参数进行比较：ICA峰值收缩速度（PSV）和PSV比值（ICA PSV/CCA PSV）。采用ROC曲线分析来评估ACCmax、ICA PSV和PSV比值与CT血管造影（CTA）得出的狭窄测量值相比作为参考测试的准确性。
研究人群包括947条颈动脉，分为3组：<50%（710/947）、50 - 69%（109/947）和≥70%（128/947）。这些组之间ACCmax有显著差异。发现ACCmax与ICA PSV（R 0.88）和PSV比值（R 0.87）之间有很强的相关性。在ROC亚分析中，ACCmax诊断≥70%的ICA狭窄时灵敏度为90%，特异度为89%，诊断≥50%的ICA狭窄时灵敏度为82%，特异度为88%。对于诊断≥50%的ICA狭窄，ACCmax的曲线下面积（AUC）（0.88）显著低于PSV比值（0.94）和ICA PSV（0.94）的AUC。对于诊断≥70%的ICA狭窄，ACCmax（0.89）、PSV比值（0.93）和ICA PSV（0.94）的AUC之间无显著差异。
ACCmax是确定ICA狭窄程度时一项有趣的额外DUS测量指标。ACCmax在狭窄远端测量，不受狭窄部位局部扭曲因素的影响。ACCmax可以准确诊断ICA狭窄，但在诊断≥50%的ICA狭窄时与ICA PSV和PSV比值相比稍显逊色。
