Huston J, Nichols D A, Luetmer P H, Rydberg C H, Lewis B D, Meyer F B, Brown R D, Schleck C D
Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn, 55950, USA.
AJNR Am J Neuroradiol. 1998 Feb;19(2):309-15.
Our objective was to determine whether appropriate criteria could be developed for performing an endarterectomy on the basis of sonographic and MR angiographic findings.
Fifty patients were examined prospectively with sonography, MR angiography, and conventional angiography. All three imaging studies were performed within 2 weeks of one another, and conventional angiography served as the reference standard.
All 10 carotid occlusions were detected with sonography and MR angiography. Sonography accurately showed flow in two arteries, and MR angiography showed flow in one of three nearly occluded arteries with extremely slow flow. Multislab three-dimensional time-of-flight MR angiographic sequences underestimated the degree of stenosis in 12 arteries, and in two cases this resulted from high T1 signal within the atherosclerotic plaque. With conventional angiography as the reference standard for 70% to 99% stenosis, sonography had a sensitivity of 96%, a specificity of 91%, and a positive predictive value of 90%, while concordant sonographic findings and the presence of a signal void on multislab 3-D time-of-flight sequences had a sensitivity of 72%, a specificity of 98%, and a positive predictive value of 97%.
Endarterectomy performed on the basis of sonographic findings of 70% to 99% stenosis and of a signal void on multislab 3-D time-of-flight MR angiographic sequences is appropriate.
我们的目标是确定能否根据超声和磁共振血管造影结果制定出合适的标准来指导动脉内膜切除术。
对50例患者进行了前瞻性的超声、磁共振血管造影及传统血管造影检查。这三项影像学检查在彼此相隔2周内完成，传统血管造影作为参考标准。
超声和磁共振血管造影检测出了所有10例颈动脉闭塞。超声准确显示了两条动脉中的血流，磁共振血管造影显示了三条几乎闭塞且血流极慢的动脉中的一条有血流。多层面三维时间飞跃磁共振血管造影序列低估了12条动脉的狭窄程度，在两例中这是由动脉粥样硬化斑块内的高T1信号导致的。以传统血管造影作为70%至99%狭窄的参考标准时，超声的敏感性为96%，特异性为91%，阳性预测值为90%，而超声检查结果一致且多层面三维时间飞跃序列上存在信号缺失时，敏感性为72%，特异性为98%，阳性预测值为97%。
基于超声检查发现70%至99%狭窄以及多层面三维时间飞跃磁共振血管造影序列上存在信号缺失来进行动脉内膜切除术是合适的。
