Turnipseed W D, Kennell T W, Turski P A, Acher C W, Hoch J R
Department of Surgery, University of Wisconsin, Madison.
Surgery. 1993 Oct;114(4):643-8; discussion 648-9.
This report describes our experience with the use of duplex imaging and magnetic resonance angiography (MRA) in the diagnosis and management of 70 patients with symptomatic carotid artery disease. Prospective evaluation of our first 30 patients showed that duplex imaging and MRA accurately correlated with conventional cerebral arteriograms (XRA) in patients with symptoms with greater than 70% ipsilateral carotid artery stenoses. In MRA versus XRA accuracy was 94%, sensitivity 100%, and specificity 93%. With duplex scanning versus XRA accuracy was 88%, sensitivity 93%, and specificity 93%.
We are now performing carotid endarterectomy on patients with symptoms without preoperative XRA when there is exact correlation between duplex imaging and MRA. Patients must have focal hemispheric symptoms, ipsilateral duplex peak systolic velocity greater than 2 m/sec, and high-quality MRA imaging of the carotid vessels.
We have prospectively entered 40 patients for preoperative evaluation with duplex imaging and MRA. High-quality MRA and duplex studies were obtained in 35 patients (88%). XRA was required in the remaining five patients (12%) because of discrepancies between duplex scanning and MRA. Endarterectomy was performed without morbidity or death. Combined use of duplex scanning and MRA eliminated XRA in 35 cases and created a net savings of more than $125,000.
Our experience suggests that preoperative XRA may not be necessary when duplex imaging and MRA confirm the presence of severe extracranial disease.
本报告描述了我们使用双功超声成像和磁共振血管造影（MRA）诊断和治疗70例有症状颈动脉疾病患者的经验。对我们最初30例患者的前瞻性评估表明，对于同侧颈动脉狭窄超过70%且有症状的患者，双功超声成像和MRA与传统脑动脉造影（XRA）结果准确相关。在MRA与XRA的对比中，准确率为94%，敏感性为100%，特异性为93%。在双功扫描与XRA的对比中，准确率为88%，敏感性为93%，特异性为93%。
当双功超声成像和MRA结果确切相关时，我们现在对有症状但未进行术前XRA的患者进行颈动脉内膜切除术。患者必须有局灶性半球症状、同侧双功超声收缩期峰值速度大于2米/秒，以及高质量的颈动脉MRA成像。
我们前瞻性地纳入了40例患者进行术前双功超声成像和MRA评估。35例患者（88%）获得了高质量的MRA和双功超声检查结果。其余5例患者（12%）因双功扫描和MRA结果不一致而需要进行XRA检查。实施内膜切除术后无并发症或死亡发生。双功扫描和MRA联合使用在35例病例中无需进行XRA检查，净节省费用超过12.5万美元。
我们的经验表明，当双功超声成像和MRA证实存在严重颅外疾病时，术前XRA可能并非必要。
