Chen J C, Salvian A J, Taylor D C, Teal P A, Marotta T R, Hsiang Y N
Department of Surgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada.
Ann Vasc Surg. 1998 May;12(3):244-7. doi: 10.1007/s100169900147.
This study prospectively compared the accuracy of published duplex ultrasonographic criteria for 70%-99% internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method to determine angiographic stenosis. From March 1, 1995 to December 1, 1995, all patients considered for carotid endarterectomy (CEA) were studied with carotid duplex ultrasound and carotid angiography within 1 month of the ultrasound study. Duplex measurements of ICA peak systolic velocity (PSV), end diastolic velocity (EDV), and ratio of the ICA to common carotid artery (CCA) PSVs were recorded. Degree of stenosis on angiography was determined using NASCET criteria. A MEDLINE search to identify duplex ultrasound criteria to predict NASCET defined 70%-99% ICA stenosis was carried out. In addition, the original University of Washington criteria for critical stenosis (> or = 80%) was also examined. The accuracy of these criteria was determined with angiographic results and the positive predictive value (PPV) of each criterion were compared. Ninety-nine patients with 185 carotid bifurcations were available for comparison. The different duplex criteria for determining NASCET defined 70%-99% ICA stenosis were: ICA PSV > 175 cm/sec or PSV < 40 cm/sec, PSV > 230 cm/sec, ratio of ICA to CCA PSVs > 4, PSV > 130 cm/sec plus EDV > 100 cm/sec, and PSV > 270 cm/sec plus EDV > 110 cm/sec. When compared with angiography, the calculated PPVs for these criteria were 71% (73/103), 81% (71/88), 86% (67/78), 88% (62/70), and 90% (57/63), respectively. The University of Washington criteria for critical stenosis (PSV > 125 cm/sec plus EDV > 135 cm/sec) had the highest PPV at 91.6% (55/60). The University of Washington criteria for critical stenosis had the highest PPV to predict a 70%-99% angiographic stenosis.
本研究根据北美症状性颈动脉内膜切除术试验（NASCET）方法，前瞻性地比较了已发表的用于判定70%-99%颈内动脉（ICA）狭窄的双功超声标准在确定血管造影狭窄方面的准确性。1995年3月1日至1995年12月1日，所有考虑行颈动脉内膜切除术（CEA）的患者在超声检查后1个月内接受了颈动脉双功超声和颈动脉血管造影检查。记录了ICA的峰值收缩速度（PSV）、舒张末期速度（EDV）以及ICA与颈总动脉（CCA）PSV的比值的双功测量值。使用NASCET标准确定血管造影的狭窄程度。进行了MEDLINE检索以确定预测NASCET定义的70%-99% ICA狭窄的双功超声标准。此外，还检查了华盛顿大学最初的严重狭窄（≥80%）标准。根据血管造影结果确定这些标准的准确性，并比较各标准的阳性预测值（PPV）。99例患者的185个颈动脉分叉可供比较。用于判定NASCET定义的70%-99% ICA狭窄的不同双功超声标准为：ICA PSV>175 cm/秒或PSV<40 cm/秒、PSV >230 cm/秒、ICA与CCA PSV的比值>4、PSV>130 cm/秒且EDV>100 cm/秒，以及PSV>270 cm/秒且EDV>110 cm/秒。与血管造影相比，这些标准计算出的PPV分别为71%（73/103）、81%（71/88）、86%（67/78）、88%（62/70）和90%（57/63）。华盛顿大学严重狭窄标准（PSV>125 cm/秒且EDV>135 cm/秒）的PPV最高，为91.6%（55/60）。华盛顿大学严重狭窄标准在预测70%-99%血管造影狭窄方面的PPV最高。
