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目的评价血管超声检查在颈部动脉狭窄检测中的敏感度、特异度和准确度。方法对68例患者408条颅外动脉血管同时进行血管超声及数字减影血管造影(DSA)检查,以DSA为金标准,用四格表法分析血管超声检查对轻度、中度、重度狭窄及闭塞的颈部动脉血管病变检出的敏感度、特异度及准确率,超声与DSA诊断的一致性采用Kappa检验。结果对轻度血管狭窄检出的敏感度、特异度及准确率分别为45.0%、96.6%、94.4%;中度狭窄者分别为35.0%、99.5%、96.3%;重度狭窄者分别为47.6%、99.5%、96.9%;闭塞者分别为64.7%、99.5%、99.0%。与DSA比较,对轻度、中度、重度狭窄及闭塞的Kappa值分别为0.409、0.467、0.591、0.723。超声对于狭窄诊断的总体敏感度、特异度、准确率分别为66.7%、99.4%、83.1%,Kappa值为0.749。结论血管超声检查技术对于轻度、中度、重度血管狭窄及闭塞的检出准确率、特异度均较高,但是灵敏度较低,轻、中、重度狭窄与金标准的吻合度一般,对闭塞的吻合度较高,提示超声对中度狭窄以上病变有较好的诊断价值。
Objective To evaluate the sensitivity, specificity and accuracy of vascular ultrasonography in the detection of cervical artery stenosis. Methods A total of 408 extracranial arterial vessels of 68 patients underwent simultaneous ultrasound and digital subtraction angiography (DSA). DSA was used as the gold standard, and the four-grid method was used to analyze the effect of vascular ultrasonography on mild, moderate and severe stenosis And the sensitivity, specificity and accuracy of detection of occluded neck arterial lesions, Kappa test was used to verify the consistency between ultrasound and DSA. Results The sensitivity, specificity and accuracy of detection of mild vascular stenosis were 45.0%, 96.6% and 94.4% respectively; those with moderate stenosis were 35.0%, 99.5% and 96.3% respectively; those with severe stenosis were 47.6% , 99.5% and 96.9% respectively. The occlusion rate was 64.7%, 99.5% and 99.0% respectively. Compared with DSA, the Kappa values of mild, moderate, severe stenosis and occlusion were 0.409,0.467,0.591,0.723 respectively. The overall sensitivity, specificity and accuracy of ultrasound for the diagnosis of stenosis were 66.7%, 99.4% and 83.1% respectively, and the Kappa value was 0.749. Conclusions Vascular ultrasonography has higher accuracy and specificity for detection of mild, moderate and severe vascular stenosis and occlusion, but the sensitivity is lower. The coincidence of light, moderate and severe stenosis with the gold standard is normal, The coincidence is high, suggesting that ultrasound has a good diagnostic value of the lesions above the moderate stenosis.