Steinke W, Ries S, Artemis N, Schwartz A, Hennerici M
Department of Neurology, Klinikum Mannheim, University of Heidelberg, Germany.
Stroke. 1997 Oct;28(10):1981-7. doi: 10.1161/01.str.28.10.1981.
Power Doppler imaging (PDI) is a new sonographic technique that has recently been introduced for vascular application. Since the technical principles of PDI may provide increased sensitivity to visualize the continuity of blood flow in arterial stenoses, we investigated the diagnostic significance of PDI and the intermethod relationship for the measurement and classification of internal carotid artery (ICA) stenosis in comparison with both color Doppler flow imaging (CDFI) and angiography.
One hundred patients with a total of 128 ICA stenoses (50% to 69%, n = 37; 70% to 79%, n = 27; 80% to 99%, n = 64) and 12 ICA occlusions were consecutively investigated by means of PDI, CDFI, and intra-arterial angiography (n = 48). Reduction of the intrastenotic lumen was measured on longitudinal and transverse views of PDI and CDFI for the calculation of the degree of diameter and area stenosis, respectively. Angiographic stenosis was determined with the use of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and common carotid (CC) methods.
PDI provided significantly more excellent or good (92% versus 79%; P < .01) displays of the intrastenotic lumen than CDFI, particularly in complicated high-grade stenosis. While linear regression analysis demonstrated a high overall correlation between PDI and CDFI for diameter (r = .88; P < .001) and area stenosis (r = .79; P < .001), categorization of ICA stenosis revealed best agreement for 80% to 99% area stenoses. Since angiography frequently either underclassified (NASCET method) or overclassified (ECST, CC methods) the degree of ICA stenosis in comparison to both PDI and CDFI, the sonographic-angiographic correlation was only moderate (regression coefficients ranged from .62 to .70; P < .001).
PDI further improves the assessment of ICA stenosis by providing better visualization of the stenotic vascular lumen than CDFI. Sonographic imaging of the stenotic plaque on both PDI and CDFI provided a direct measurement of the local degree of stenosis, while the angiographic grade of stenosis essentially depended on the method used for evaluation.
能量多普勒成像（PDI）是一种最近被引入用于血管检查的新型超声技术。由于PDI的技术原理可能会提高对动脉狭窄处血流连续性的可视化敏感性，我们将其与彩色多普勒血流成像（CDFI）和血管造影术相比较，研究了PDI在颈内动脉（ICA）狭窄测量和分类中的诊断意义以及不同方法之间的关系。
连续对100例患者共128处ICA狭窄（50%至69%，n = 37；70%至79%，n = 27；80%至99%，n = 64）和12处ICA闭塞进行了PDI、CDFI及动脉内血管造影检查（n = 48）。在PDI和CDFI的纵向和横向视图上测量狭窄段管腔的缩小情况，分别用于计算直径狭窄程度和面积狭窄程度。血管造影狭窄程度采用北美症状性颈动脉内膜切除术试验（NASCET）、欧洲颈动脉外科试验（ECST）和颈总动脉（CC）方法确定。
与CDFI相比，PDI对狭窄段管腔的显示明显更好（优秀或良好者分别为92%和79%；P <.01），尤其在复杂的重度狭窄中。虽然线性回归分析表明PDI与CDFI在直径狭窄（r =.88；P <.001）和面积狭窄（r =.79；P <.001）方面总体相关性较高，但ICA狭窄的分类显示在面积狭窄80%至99%时一致性最佳。由于与PDI和CDFI相比，血管造影术对ICA狭窄程度的分类常常要么过低（NASCET方法）要么过高（ECST、CC方法），所以超声与血管造影的相关性仅为中等（回归系数范围为.62至.70；P <.001）。
与CDFI相比，PDI能更好地显示狭窄血管腔，从而进一步改善对ICA狭窄的评估。PDI和CDFI对狭窄斑块的超声成像可直接测量局部狭窄程度，而血管造影的狭窄分级主要取决于所采用的评估方法。
