用于各种有症状和无症状颈动脉内膜切除术试验的阈值狭窄的拟议新双重分类。
Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.
作者信息
AbuRahma A F, Robinson P A, Strickler D L, Alberts S, Young L
机构信息
Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA.
出版信息
Ann Vasc Surg. 1998 Jul;12(4):349-58. doi: 10.1007/s100169900166.
Current duplex ultrasound criteria for internal carotid artery (ICA) stenosis (1%-15%, 16%-49%, 50%-69%, 70%-99%) may not be applicable to threshold stenoses used in symptomatic (North American Symptomatic Carotid Endarterectomy Trial [NASCET], Veterans' Administration [VA]) and asymptomatic (Asymptomatic Carotid Atherosclerosis Study, VA) carotid endarterectomy (CEA) trials. This, along with increasing reports advocating CEA based on duplex results alone, prompted us to identify (1) new velocity criteria consistent with threshold stenoses used by these trials, and (2) velocity criteria with a high positive predictive value (PPV) (> 95%) and accuracy for detecting > or = 60% and > or = 70% ICA stenoses. This is the first study to propose criteria which can be used for all current CEA trials. The color duplex ultrasound (CDU) and arteriogram results of 462 ICAs were analyzed in blind fashion. Angiographic stenosis was calculated as in NASCET. Three velocity criteria (peak systolic velocity [PSV] of the ICA, end diastolic velocity [EDV] of the ICA, and the ratio of the PSV of the ICA/common carotid artery) were recorded and subjected to receiver operator characteristic curves (ROC) analysis to determine optimum criteria for identifying ICA stenoses of > or = 30%, > or = 50%, > or = 60%, and > or = 70%-99%. For > or = 30% stenosis (st): PSV > or = 120 cm/sec had an overall accuracy (OA) of 87%, sensitivity (sen.) of 93%, specificity (spec.) of 67%, PPV of 90%, and negative predictive value (NPV) of 77%; for > or = 50% st: PSV > or = 140 cm/sec had an OA of 93%, sen. of 92%, spec. of 95%, PPV of 97%, and NPV of 89%; for > or = 60% st: PSV > or = 150 cm/sec and an EDV of > or = 65 had an OA of 90%, sen. of 82%, spec. of 97%, PPV of 96%, and NPV of 86%; for > or = 70%-99% st: PSV > or = 150 cm/sec and an EDV of > or = 90 had an OA of 92%, sen. of 85%, spec. of 95%, PPV of 91%, and NPV of 92%. An ICA-PSV and EDV of 150, 65, and 150, 110 had the best PPV (> or = 95%) in detecting > or = 60% and > or = 70% st, respectively. When these new criteria are used, CDU can accurately detect threshold stenoses used by various CEA trials. Selected velocities with a high PPV (> 95%) may be used as the sole preoperative imaging.
目前用于评估颈内动脉（ICA）狭窄程度（1%-15%、16%-49%、50%-69%、70%-99%）的双功超声标准，可能不适用于有症状（北美症状性颈动脉内膜切除术试验[NASCET]、退伍军人管理局[VA]）和无症状（无症状颈动脉粥样硬化研究、VA）颈动脉内膜切除术（CEA）试验中所采用的阈值狭窄。此外，越来越多的报告主张仅依据双功超声结果进行CEA手术，这促使我们确定：（1）与这些试验所采用的阈值狭窄相一致的新速度标准；（2）对检测≥60%和≥70%的ICA狭窄具有高阳性预测值（PPV）（>95%）和准确性的速度标准。这是第一项提出可用于所有当前CEA试验标准的研究。我们以盲法分析了462条ICA的彩色双功超声（CDU）和动脉造影结果。按照NASCET的方法计算血管造影狭窄程度。记录三个速度标准（ICA的收缩期峰值速度[PSV]、ICA的舒张末期速度[EDV]以及ICA/颈总动脉的PSV比值），并进行受试者操作特征曲线（ROC）分析，以确定识别≥30%、≥50%、≥60%和≥70%-99%的ICA狭窄的最佳标准。对于≥30%狭窄（st）：PSV≥120 cm/秒，总体准确率（OA）为87%，敏感性（sen.）为93%，特异性（spec.）为67%，PPV为90%，阴性预测值（NPV）为77%；对于≥50% st：PSV≥140 cm/秒，OA为93%，sen.为92%，spec.为95%，PPV为97%，NPV为89%；对于≥60% st：PSV≥150 cm/秒且EDV≥65，OA为90%，sen.为82%，spec.为97%，PPV为96%，NPV为86%；对于≥70%-99% st：PSV≥150 cm/秒且EDV≥90，OA为92%，sen.为85%，spec.为95%，PPV为91%，NPV为92%。ICA-PSV为150、EDV为65以及ICA-PSV为150、EDV为110时，在检测≥60%和≥70% st方面分别具有最佳PPV（>或=95%）。当采用这些新标准时CDU能够准确检测各种CEA试验所采用的阈值狭窄。具有高PPV（>95%）的选定速度可作为唯一的术前影像学检查。
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