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目的探讨经颅多普勒超声(TCD)在颈动脉狭窄患者灌注评估上的价值。方法连续选择2011年10月至2012年12月在浙江大学医学院附属第一医院神经内科全脑数字减影血管造影(DSA)证实的单侧颈动脉狭窄的患者24例,进行TCD及CT灌注(CTP)评估,比较两者的诊断结果。结果 CTP提示灌注正常者12例,灌注不足者12例。两组患侧大脑中动脉(MCA)的搏动指数(PI)及阻力指数(RI)值和对侧比较,差异有统计学意义(P<0.01),而单纯血流数值差异无统计学意义。在相关性分析中,患侧MCA与对侧MCA的PI及RI比值与对比剂峰值时间(TTP)相关性最强(r=0.61,P=0.002)。在诊断的准确性评价上,患侧MCA与对侧MCA收缩期流速比值的诊断意义最大,当比值为0.63时,其诊断敏感度为91.7%,特异度为91.7%,约登指数为0.83,曲线下面积0.771(P<0.01)。结论TCD作为颈动脉狭窄患者灌注评估方式是可靠的,而其中患侧MCA与对侧MCA收缩期流速比值对MCA供血区低灌注的诊断意义最大。
Objective To investigate the value of transcranial Doppler ultrasound (TCD) in assessment of perfusion in patients with carotid artery stenosis. Methods Twenty-four consecutive patients with unilateral carotid artery stenosis confirmed by digital subtraction angiography (DSA) of the Department of Neurology, the First Affiliated Hospital of Medical College of Zhejiang University from October 2011 to December 2012 were selected for TCD and CT perfusion (CTP) assessment, comparing the diagnosis of both. Results CTP prompt perfusion in 12 cases, hypothyroidism in 12 cases. The pulsatility index (PI), resistance index (RI) and contralateral contrast of MCA in both groups were statistically significant (P <0.01), while there was no significant difference in the value of simple blood flow. In the correlation analysis, PI and RI ratios of ipsilateral MCA and contralateral MCA had the strongest correlation with TTP (r = 0.61, P = 0.002). The accuracy of diagnostic accuracy, ipsilateral MCA and contralateral MCA systolic flow rate ratio of the diagnosis of the most significance, when the ratio of 0.63, the diagnostic sensitivity was 91.7%, the specificity was 91.7%, the Youden index was 0.83, The area under the curve was 0.771 (P <0.01). Conclusion The perfusion assessment method of TCD in patients with carotid artery stenosis is reliable. However, the systolic flow rate ratio of MCA and contralateral MCA in MCA is the most important for the diagnosis of hypoperfusion in MCA.