Young G R, Humphrey P R, Shaw M D, Nixon T E, Smith E T
Walton Centre for Neurology and Neurosurgery, Rice, Liverpool, UK.
J Neurol Neurosurg Psychiatry. 1994 Dec;57(12):1466-78. doi: 10.1136/jnnp.57.12.1466.
The results of a prospective study comparing ultrasound, intra-arterial digital subtraction angiography, and magnetic resonance angiography in the assessment of the degree of extracranial internal carotid artery stenosis are reported in patients with symptoms of recent carotid territory ischaemia. A total of 70 patients and 137 vessels were examined by all three techniques. The results obtained by each technique were reported blind. The mean difference (SD) for the comparison of magnetic resonance angiography and digital subtraction angiography was -0.7 (14)%, for ultrasound and digital subtraction angiography 3.1 (15)%, and for magnetic resonance angiography and ultrasound -3.8 (15)%. The level of agreement was greater for the more tightly stenosed vessels. With the assumption that the results of the digital subtraction angiogram reflect the true situation, the sensitivity and specificity in the detection of > or = 30% stenoses were 93% and 82% with ultrasound and 89% and 82% with magnetic resonance angiography; for stenoses > or = 70% 93% and 92% with ultrasound and 90% and 95% with magnetic resonance angiography; and for stenoses of 70-99% 89% and 93% with ultrasound and 86% and 93% with magnetic resonance angiography. For occlusion the values were 93% and 99% with ultrasound and 80% and 99% with magnetic resonance angiography. Increased sensitivity and specificity were obtained when analysis was confined to those vessels in which ultrasound and magnetic resonance angiography were in agreement over classification. It is thus possible to accurately categorize the degree of stenosis of the extracranial internal carotid artery from a combination of ultrasound and magnetic resonance angiography. The adoption of this combination for the investigation of patients before carotid endarterectomy removes the risk associated with conventional angiography and represents an important advance in the management of carotid stenosis.
本文报告了一项前瞻性研究的结果，该研究比较了超声、动脉内数字减影血管造影和磁共振血管造影在评估近期有颈动脉供血区缺血症状患者的颅外颈内动脉狭窄程度中的应用。共有70例患者的137条血管接受了这三种技术的检查。每种技术所获得的结果均采用盲法报告。磁共振血管造影与数字减影血管造影比较的平均差值（标准差）为-0.7（14）%，超声与数字减影血管造影比较为3.1（15）%，磁共振血管造影与超声比较为-3.8（15）%。狭窄程度越严重的血管，一致性水平越高。假设数字减影血管造影的结果反映真实情况，超声检测≥30%狭窄的敏感性和特异性分别为93%和82%，磁共振血管造影为89%和82%；对于≥70%的狭窄，超声为93%和92%，磁共振血管造影为90%和95%；对于70 - 99%的狭窄，超声为89%和93%，磁共振血管造影为86%和93%。对于闭塞情况，超声的值为93%和99%，磁共振血管造影为80%和99%。当分析仅限于超声和磁共振血管造影在分类上一致的血管时，敏感性和特异性有所提高。因此，通过超声和磁共振血管造影相结合可以准确地对颅外颈内动脉狭窄程度进行分类。在颈动脉内膜切除术之前采用这种联合检查方法可消除传统血管造影相关的风险，是颈动脉狭窄治疗管理中的一项重要进展。
