经颅多普勒与血管造影术在颅内狭窄检测中的相关性

Transcranial Doppler correlation with angiography in detection of intracranial stenosis.

作者信息

Rorick M B, Nichols F T, Adams R J

机构信息

Department of Neurology, Case Western Reserve University, Cleveland, Ohio.

出版信息

Stroke. 1994 Oct;25(10):1931-4. doi: 10.1161/01.str.25.10.1931.

DOI:10.1161/01.str.25.10.1931

PMID:7916499

Abstract

BACKGROUND AND PURPOSE

The purpose of this study was to evaluate the use of velocity criteria applied to transcranial Doppler (TCD) signals in the detection of stenosis of the middle cerebral (MCA), distal vertebral, and basilar arteries.

METHODS

Sixty-five patients who underwent both cerebral angiography and transcranial Doppler examinations in the workup of acute cerebral ischemia were reviewed. Angiography was performed a mean of 7 +/- 5 days (range, 1 to 28 days) after TCD. Interpretation of the angiogram was performed without input regarding the TCD findings. TCD interpretation was performed according to standard criteria.

RESULTS

When we used a mean velocity (MV) cutoff of > or = 80 cm/s in the MCA as the criterion for stenosis, 10 of 12 stenoses of any degree were detected by TCD, with 11 of 87 false-positives. Nine of 12 MCA stem (M1) stenoses were detected when a cutoff of > or = 90 cm/s was used, with 7 of 87 false-positives. When we used an MV cutoff of > or = 70 cm/s as the criterion for > or = 50% stenosis of the vertebrobasilar system, 5 of 6 stenoses were detected, with 15 of 85 false-positives. The most important confounding factor was the presence of > or = 75% stenosis of the extracranial internal carotid artery, resulting in both false-positive (from collateral flow) and false-negative (decreased volume flow from the proximal stenosis without adequate collateral flow) errors in TCD interpretation. When patients with > or = 75% stenosis of the cervical internal carotid artery were excluded from analysis, a TCD MV cutoff of > or = 80 cm/s identified 9 of 10 M1 lesions with 7 of 61 false-positives, and an MV of > or = 70 cm/s identified 3 of 4 vertebrobasilar lesions causing > or = 50% stenosis with 7 of 56 false-positives.

CONCLUSIONS

TCD may be an effective screening test for M1 stenosis when velocity criteria alone are used. TCD may less reliably detect intracranial vertebral and basilar artery stenosis.

摘要

背景与目的

本研究旨在评估应用于经颅多普勒（TCD）信号的速度标准在检测大脑中动脉（MCA）、椎动脉远端及基底动脉狭窄中的应用情况。

方法

回顾了65例在急性脑缺血检查中同时接受脑血管造影和经颅多普勒检查的患者。脑血管造影在TCD检查后平均7±5天（范围1至28天）进行。血管造影的解读不参考TCD检查结果。TCD检查结果根据标准标准进行解读。

结果

当我们将MCA中平均速度（MV）≥80 cm/s作为狭窄标准时，12例任何程度的狭窄中有10例被TCD检测到，87例假阳性中有11例。当采用≥90 cm/s的临界值时，12例MCA主干（M1）狭窄中有9例被检测到，87例假阳性中有7例。当我们将MV≥70 cm/s作为椎基底系统≥50%狭窄的标准时，6例狭窄中有5例被检测到，85例假阳性中有15例。最重要的混杂因素是颅外颈内动脉存在≥75%的狭窄，导致TCD解读出现假阳性（来自侧支血流）和假阴性（近端狭窄导致血流减少且侧支血流不足）错误。当将颈内动脉狭窄≥75%的患者排除在分析之外时，TCD的MV≥80 cm/s可识别出10例M1病变中的9例，61例假阳性中有7例；MV≥70 cm/s可识别出4例导致≥50%狭窄的椎基底病变中的3例，56例假阳性中有7例。