Sitzer M, Fürst G, Fischer H, Siebler M, Fehlings T, Kleinschmidt A, Kahn T, Steinmetz H
Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.
Stroke. 1993 Oct;24(10):1513-8. doi: 10.1161/01.str.24.10.1513.
The degree of internal carotid stenosis has emerged as the most important predictor of ischemic stroke in extracranial carotid artery disease. The purpose of this study was to assess the validity of the noninvasive techniques for quantifying internal carotid stenosis with respect to the accepted standard of intra-arterial angiography.
We measured the maximum percentage reduction in luminal diameter on the intra-arterial digital subtraction angiograms of 56 symptomatic patients with extracranial internal carotid stenosis (n = 77) or occlusion (n = 20). These data were compared with independent measurements based on continuous-wave Doppler ultrasonography, pulsed-wave Doppler spectrum analysis, color Doppler-assisted duplex imaging, and magnetic resonance angiography.
Correlations with intra-arterial angiography were equally strong (r > .90) for magnetic resonance angiography, continuous-wave Doppler, and color duplex analysis. Positive and negative predictive values for (therapeutically relevant) 70% to 99% stenosis were higher for continuous-wave Doppler (.82, .97) and color duplex (.84, .98) than for magnetic resonance angiography (.79, .81). Also, accuracy in quantifying high-grade stenosis was better for both of these ultrasonographic techniques, mainly due to the frequent occurrence of a "flow gap" on the magnetic resonance angiograms. Continuous-wave Doppler and magnetic resonance angiography, but not color duplex, failed to detect slow residual arterial flow in one and two cases of symptomatic "pseudo-occlusion" of the internal carotid, respectively.
(1) Several noninvasive methods compare well with intra-arterial angiography in identifying and quantifying high-grade internal carotid stenosis; (2) the use of these noninvasive methods may suffice for treatment decisions; and (3) because residual between-method disagreement is partly explained by principles of physics, the validity of continuous-wave Doppler and color duplex in quantifying 60% to 99% stenosis is likely to be underestimated by correlation with intra-arterial angiography.
颈内动脉狭窄程度已成为颅外颈动脉疾病缺血性卒中最重要的预测指标。本研究旨在根据动脉内血管造影这一公认标准，评估非侵入性技术对颈内动脉狭窄进行定量分析的有效性。
我们在56例有症状的颅外颈内动脉狭窄（n = 77）或闭塞（n = 20）患者的动脉内数字减影血管造影上测量管腔直径的最大百分比缩小。将这些数据与基于连续波多普勒超声、脉冲波多普勒频谱分析、彩色多普勒辅助双功成像和磁共振血管造影的独立测量结果进行比较。
磁共振血管造影、连续波多普勒和彩色双功分析与动脉内血管造影的相关性同样很强（r >.90）。连续波多普勒（.82，.97）和彩色双功（.84，.98）对（具有治疗相关性的）70%至99%狭窄的阳性和阴性预测值高于磁共振血管造影（.79，.81）。此外，这两种超声技术在量化重度狭窄方面的准确性更高，主要是因为磁共振血管造影上频繁出现“血流间隙”。连续波多普勒和磁共振血管造影分别在1例和2例有症状的颈内动脉“假性闭塞”病例中未能检测到缓慢的残余动脉血流，但彩色双功成像未出现这种情况。
（1）几种非侵入性方法在识别和量化重度颈内动脉狭窄方面与动脉内血管造影具有良好的可比性；（2）使用这些非侵入性方法可能足以做出治疗决策；（3）由于方法间的残余差异部分可由物理原理解释，与动脉内血管造影的相关性可能会低估连续波多普勒和彩色双功在量化60%至99%狭窄方面的有效性。
