Department of Ultrasonography, Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Eur Rev Med Pharmacol Sci. 2023 Jan;27(1):224-232. doi: 10.26355/eurrev_202301_30875.
To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced transcranial color-coded sonography (CE-TCCS), using digital subtraction angiography (DSA) as the golden diagnostic standard.
We collected data from 104 patients with suspected stroke treated in our hospital between December 2019 and October 2021. The detection rate of the intracranial circle of Willis, anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were analyzed based on routine TCCS and CE-TCCS data. Based on digital subtraction angiography (DSA) data, the degree of MCA stenosis was divided into mild stenosis (<50%), moderate stenosis (50-69%), severe stenosis (70-99%), and bilateral middle cerebral artery CE-TCCS examinations were performed. We evaluated MCA color blood flow on CE-TCCS, and recorded the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MFV).
The display rates of ACA, MCA, and PCA were significantly improved on the CE-TCCS, and the PSV, EDV and MFV of the MCA stenosis group were higher than those of the normal group. The flow velocity of each stenosis subgroup was increased compared to the normal group. The optimal cutoff values of normal and stenosis under the receiver operating characteristic (ROC) curve were PSV = 168.5 cm/s, EDV = 61.5 cm/s, and MFV = 110.5 cm/s. The optimal cutoff values for mild and moderate stenosis and for moderate and severe stenosis were PSV = 201.5 cm/s and 249.5 m/s, EDV = 95.2 cm/s and 141.5 cm/s, and MFV = 137.6 cm/s and 160.5 cm/s, respectively. PSV and MFV had the most significant sensitivity, specificity, and accuracy.
Transcranial contrast-enhanced ultrasonography can improve the display rate of intracranial blood vessels and can accurately diagnose MCA stenosis.
应用经颅对比增强经颅彩色编码超声（CE-TCCS）检测颅内 Willis 环（前、中、后大脑动脉）的显示率和血流速度，以数字减影血管造影（DSA）为金标准。
我们收集了 2019 年 12 月至 2021 年 10 月期间在我院治疗的 104 例疑似中风患者的数据。基于常规 TCCS 和 CE-TCCS 数据，分析颅内 Willis 环、大脑前动脉（ACA）、大脑中动脉（MCA）和大脑后动脉（PCA）的检测率。基于数字减影血管造影（DSA）数据，将 MCA 狭窄程度分为轻度狭窄（<50%）、中度狭窄（50%-69%）、重度狭窄（70%-99%），并对双侧 MCA 进行 CE-TCCS 检查。我们评估了 CE-TCCS 上 MCA 彩色血流，并记录了收缩期峰值速度（PSV）、舒张末期速度（EDV）和平均血流速度（MFV）。
CE-TCCS 显著提高了 ACA、MCA 和 PCA 的显示率，MCA 狭窄组的 PSV、EDV 和 MFV 均高于正常组。各狭窄亚组的血流速度均高于正常组。ROC 曲线下正常和狭窄的最佳截断值为 PSV=168.5cm/s、EDV=61.5cm/s 和 MFV=110.5cm/s。轻中度狭窄和中度重度狭窄的最佳截断值分别为 PSV=201.5cm/s 和 249.5m/s、EDV=95.2cm/s 和 141.5cm/s、MFV=137.6cm/s 和 160.5cm/s。PSV 和 MFV 的灵敏度、特异度和准确度最高。
经颅对比增强超声可以提高颅内血管的显示率，能够准确诊断 MCA 狭窄。
