Hetzel A, Eckenweber B, Trummer B, Wernz M, Schumacher M, von Reutern G
Department of Neurology, University Clinics Freiburg, Breisacherstr. 64, D-79106, Freiburg, Germany.
Eur J Ultrasound. 1998 Dec;8(3):183-91. doi: 10.1016/s0929-8266(98)00074-3.
The accuracy of colour-coded duplex sonography (CCDS) for differentiating preocclusive stenoses from occlusions of the internal carotid artery (ICA) is a crucial point in non-invasive quantification of atherosclerotic lesions prior to carotid endarterectomy.
A total of 401 consecutive patients with CCDS followed by ICA arteriographies as gold standard was available for comparison. The entire number was divided into groups of <90%, 90-94%, preocclusive (95-99%) stenoses and occlusions. Sensitivity, specificity, and predictive value for distinguishing these groups were calculated using a contingency table.
With CCDS we found a sensitivity of 88% and a specificity of 99% in 43 preocclusive ?95% stenoses. Similar findings were seen in 31 occlusions of the ICA (SE 87%, SP 99%). CCDS accurately differentiates the subgroups of severe carotid obstructions (90-94%, ?95% and occluded) shown by a predictive accuracy of 97, 96 and 93%. Carotid endarterectomies were performed in two of three angiographically occluded but sonographically preocclusive arteries. Intraoperatively preocclusive ICAs were seen in both cases.
CCDS showed a high accuracy for differentiating preocclusive stenoses and occlusion of the ICA. Intraoperative findings indicated that angiography is not the absolute gold standard for preocclusive carotid disease in every case. Irregularities of the stenosis channel make it impossible to estimate the true area reduction in stenoses ?90%. The hemodynamic estimation of degree of stenosis by Doppler ultrasound may be closer to reality than angiographic measurement.
在进行颈动脉内膜切除术之前，对动脉粥样硬化病变进行无创定量分析时，彩色编码双功超声（CCDS）鉴别颈内动脉（ICA）的闭塞前期狭窄与闭塞的准确性是一个关键点。
共有401例连续患者接受了CCDS检查，随后以ICA动脉造影作为金标准进行比较。将全部患者分为狭窄程度<90%、90 - 94%、闭塞前期（95 - 99%）狭窄和闭塞组。使用列联表计算区分这些组别的敏感性、特异性和预测值。
对于43例闭塞前期≥95%狭窄，采用CCDS检查时，我们发现敏感性为88%，特异性为99%。在31例ICA闭塞病例中也观察到了类似结果（敏感性87%，特异性99%）。CCDS能准确区分严重颈动脉阻塞的亚组（90 - 94%、≥95%和闭塞），预测准确率分别为97%、96%和93%。在3例血管造影显示闭塞但超声检查为闭塞前期的动脉中，有2例进行了颈动脉内膜切除术。术中在这2例中均发现为闭塞前期ICA。
CCDS在鉴别ICA的闭塞前期狭窄和闭塞方面显示出较高的准确性。术中发现表明，血管造影并非在每种情况下都是闭塞前期颈动脉疾病的绝对金标准。狭窄通道的不规则性使得无法估计≥90%狭窄时的真实面积缩小情况。多普勒超声对狭窄程度的血流动力学评估可能比血管造影测量更接近实际情况。
