早期对比增强经颅彩色编码双功超声在急性卒中中的诊断价值及预后相关性

Diagnostic impact and prognostic relevance of early contrast-enhanced transcranial color-coded duplex sonography in acute stroke.

作者信息

Goertler M, Kross R, Baeumer M, Jost S, Grote R, Weber S, Wallesch C W

机构信息

Department of Neurology, University of Magdeburg, Germany.

出版信息

Stroke. 1998 May;29(5):955-62. doi: 10.1161/01.str.29.5.955.

DOI:10.1161/01.str.29.5.955

PMID:9596242

Abstract

BACKGROUND AND PURPOSE

We sought to evaluate the diagnostic value of echo-enhanced transcranial color-coded duplex sonography (TCCD) and the clinical relevance of vascular pathology assessed by sonography for early clinical outcome in acute ischemic stroke.

METHODS

We present 23 consecutive patients with an anterior circulation stroke in whom clinical examination, CT, and ultrasonography were performed within 5 hours after the onset of symptoms. Transcranial Doppler sonography (TCD) and unenhanced and contrast-enhanced TCCD (Levovist, 4 g, 300 mg/mL) were compared for their ability to detect middle cerebral artery (MCA) occlusion and flow velocity reduction suggesting hemodynamic impairment in the MCA distribution pathway. Sonographic examination times were registered. Baseline clinical characteristics and CT findings were assessed. Neurological deficit was quantified according to the National Institutes of Health Stroke Scale score, with an early clinical improvement defined as decrease of the score by 4 or more points or a complete resolution of the deficit on day 4.

RESULTS

Contrast-enhanced TCCD enabled diagnosis of intracranial vascular pathology in 20 affected hemispheres, whereas unenhanced TCCD and TCD were conclusive in 7 and 14 hemispheres, respectively (P=0.0001). Contrast-enhanced TCCD was superior in evaluating distal carotid (carotid-T) occlusion and differentiating major vessel occlusions from patent arteries with flow velocity diminution. Mean examination time for enhanced TCCD ranged from 5 to 7 minutes, depending on the number of investigated vessels (without or with MCA branches). Logistic regression selected a patent MCA without reduced blood flow velocity as the only independent predictor for an early clinical improvement (P<0.01).

CONCLUSIONS

Contrast-enhanced TCCD is a promising tool for early prognosis in anterior circulation stroke. It is considered superior to unenhanced TCCD and TCD.

摘要

背景与目的

我们旨在评估超声增强经颅彩色编码双功能超声（TCCD）的诊断价值，以及通过超声评估的血管病变与急性缺血性卒中早期临床结局的临床相关性。

方法

我们纳入了23例连续的前循环卒中患者，在症状发作后5小时内进行了临床检查、CT和超声检查。比较经颅多普勒超声（TCD）以及未增强和增强的TCCD（声诺维，4 g，300 mg/mL）检测大脑中动脉（MCA）闭塞以及提示MCA分布途径血流动力学损害的血流速度降低的能力。记录超声检查时间。评估基线临床特征和CT表现。根据美国国立卫生研究院卒中量表评分对神经功能缺损进行量化，早期临床改善定义为第4天时评分降低4分或更多分或缺损完全消失。

结果

增强TCCD能够诊断20个受累半球的颅内血管病变，而未增强TCCD和TCD分别在7个和14个半球中得出明确诊断（P = 0.0001）。增强TCCD在评估颈内动脉终末段（颈动脉-T）闭塞以及区分主要血管闭塞与血流速度降低的通畅动脉方面更具优势。增强TCCD的平均检查时间为5至7分钟，具体取决于所检查血管的数量（有无MCA分支）。逻辑回归分析选择无血流速度降低的通畅MCA作为早期临床改善的唯一独立预测因素（P<0.01）。