de Smet A A, Ermers E J, Kitslaar P J
Department of Surgery, University Hospital Maastricht, The Netherlands.
J Vasc Surg. 1996 Apr;23(4):628-36. doi: 10.1016/s0741-5214(96)80043-7.
It is now possible to grade aortoiliac stenoses in broad categories based on peak systolic velocity (PSV) changes. The goal of this study was to see whether additional simple Doppler parameters would improve the grading of aortoiliac obstructive disease.
Duplex parameters were compared in 112 aortoiliac segments with four categories of arteriographic diameter reduction and four categories of common femoral artery pressure measurements. These parameters were PSV, PSV ratio, PSV difference, end diastolic velocity (EDV), the presence or absence of reverse flow, and the presence or absence of spectral broadening.
The discriminative value of the PSV ratio was better than that of either the absolute PSV value or the PSV difference. A PSV ratio < 1.5 combined with reverse flow and a clear systolic window in the Doppler spectrum predicted a diameter reduction < 20% (sensitivity, 100%; specificity, 58%; positive predictive value [PPV], 89%; negative predictive value [NPV], 100%; accuracy, 90%). For the detection of > or = 50% aortoiliac stenoses, a PSV ratio > or = 2.8 provided 86% sensitivity and 84% specificity (PPV, 84%; NPV, 85%, accuracy, 85%). An absolute PSV value of 200 cm/sec has a high sensitivity (95%) but a low specificity (55%) in identifying > or = 50% stenoses (PPV, 68%; NPV, 91%; accuracy 75%). An EDV > 0 cm/sec at the stenosis indicates a femorobrachial pressure index < 0.90 with 51% sensitivity and 89% specificity. An EDV > or = 40 cm/sec indicates a femorobrachial index < 0.80 with 50% sensitivity and 89% specificity, and indicates > or = 75% arteriographic stenoses with 70% sensitivity and 90% specificity (PPV, 64%; NPV, 92%; accuracy, 86%). A stenosis > or = 75% was also identified by a PSV ratio of 5.0 with 65% sensitivity and 91% specificity (PPV, 65%; NPV, 91%; accuracy, 86%).
The PSV ratio is the most important parameter to grade aortoiliac stenoses into < 20%, 20% to 49%, 50% to 74%, and 75% to 99% categories, but additional parameters such as absolute PSV value, EDV, and the presence or absence of reverse flow and spectral broadening in the Doppler spectrum are helpful in gradation.
现在可以根据收缩期峰值流速（PSV）变化对主髂动脉狭窄进行大致分类。本研究的目的是观察是否有其他简单的多普勒参数能改善主髂动脉阻塞性疾病的分级。
对112个主髂动脉节段的双功超声参数进行比较，这些节段具有四类动脉造影直径缩小和四类股总动脉压力测量值。这些参数包括PSV、PSV比值、PSV差值、舒张末期流速（EDV）、有无逆流以及有无频谱增宽。
PSV比值的鉴别价值优于绝对PSV值或PSV差值。PSV比值<1.5，同时伴有逆流和多普勒频谱中清晰的收缩期窗，提示直径缩小<20%（敏感性，100%；特异性，58%；阳性预测值[PPV]，89%；阴性预测值[NPV]，100%；准确性，90%）。对于检测主髂动脉狭窄≥50%，PSV比值≥2.8的敏感性为86%，特异性为84%（PPV，84%；NPV，85%，准确性，85%）。绝对PSV值为200 cm/秒在识别≥50%狭窄时具有高敏感性（95%）但低特异性（55%）（PPV，68%；NPV，91%；准确性75%）。狭窄处EDV>0 cm/秒提示股肱压力指数<0.90，敏感性为51%，特异性为89%。EDV≥40 cm/秒提示股肱指数<0.80，敏感性为50%，特异性为89%，提示动脉造影狭窄≥75%，敏感性为70%，特异性为90%（PPV，64%；NPV，92%；准确性，86%）。PSV比值为5.0也可识别≥75%的狭窄，敏感性为65%，特异性为91%（PPV，65%；NPV，91%；准确性，86%）。
PSV比值是将主髂动脉狭窄分为<20%、20%至49%、50%至7�%和75%至99%类别最重要的参数，但其他参数如绝对PSV值、EDV以及多普勒频谱中有无逆流和频谱增宽有助于分级。
