CAJ | 학술논문

目的：探讨经颅多普勒超声（TCD）或经颅彩色多普勒超声（TCCS）联合评估基底动脉狭窄性病变的血流动力学参数标准及准确性。方法连续纳入2012年6月至2014年6月首都医科大学宣武医院同期进行TCD及TCCS检测，并经过数字减影血管造影（DSA）证实的基底动脉狭窄患者261例，记录基底动脉狭窄患者基底动脉收缩期峰值流速（PSVBA）、舒张末期流速（EDVBA）与平均流速（MFVBA）、狭窄处距体表的检测深度（D），并计算基底动脉与双侧椎动脉颅内段、大脑后动脉PSV（取较高侧测值）比值（PSVBA/PSVVA和PSVBA/PSVPCA），以DSA检查结果为标准计算PSVBA、EDVBA、MFVBA、PSVBA/PSVVA及PSVBA/PSVPCA的受试者操作特性（ROC）曲线下面积，比较上述各参数在不同取值下的敏感度、特异度及准确性。结果（1）基底动脉近段狭窄发生于（90±5.4）mm处，中段狭窄发生于（97±3.0）mm处，而远段狭窄常发生于（104±4.2）mm处。（2）基底动脉狭窄诊断最佳血流动力学参数：轻度狭窄的最佳参数标准为110 cm/s≤PSV≤150 cm/s或65 cm/s≤MFV≤90 cm/s。中度狭窄为150 cm/s≤PSV≤210 cm/s或90 cm/s≤MFV≤135 cm/s。重度狭窄为PSVBA≥210 cm/s或PSVBA/PSVVA≥3.5。结论 TCD或TCCS联合评估基底动脉狭窄，选择PSV、MFV及PSVBA/PSVVA血流动力学参数可以准确评估基底动脉狭窄性病变。
목적：탐토경로다보륵초성（TCD）혹경로채색다보륵초성（TCCS）연합평고기저동맥협착성병변적혈류동역학삼수표준급준학성。방법련속납입2012년6월지2014년6월수도의과대학선무의원동기진행TCD급TCCS검측，병경과수자감영혈관조영（DSA）증실적기저동맥협착환자261례，기록기저동맥협착환자기저동맥수축기봉치류속（PSVBA）、서장말기류속（EDVBA）여평균류속（MFVBA）、협착처거체표적검측심도（D），병계산기저동맥여쌍측추동맥로내단、대뇌후동맥PSV（취교고측측치）비치（PSVBA/PSVVA화PSVBA/PSVPCA），이DSA검사결과위표준계산PSVBA、EDVBA、MFVBA、PSVBA/PSVVA급PSVBA/PSVPCA적수시자조작특성（ROC）곡선하면적，비교상술각삼수재불동취치하적민감도、특이도급준학성。결과（1）기저동맥근단협착발생우（90±5.4）mm처，중단협착발생우（97±3.0）mm처，이원단협착상발생우（104±4.2）mm처。（2）기저동맥협착진단최가혈류동역학삼수：경도협착적최가삼수표준위110 cm/s≤PSV≤150 cm/s혹65 cm/s≤MFV≤90 cm/s。중도협착위150 cm/s≤PSV≤210 cm/s혹90 cm/s≤MFV≤135 cm/s。중도협착위PSVBA≥210 cm/s혹PSVBA/PSVVA≥3.5。결론 TCD혹TCCS연합평고기저동맥협착，선택PSV、MFV급PSVBA/PSVVA혈류동역학삼수가이준학평고기저동맥협착성병변。
ObjectiveTo investigate the accuracy of hemodynamic parameters of diagnostic criteria for basilar artery stenosis by transcranial Doppler (TCD) combined with transcranial color code sonography (TCCS).Methods261 cases with basilar artery stenosis detected by TCD or TCCS and confirmed by DSA were included in this study. The velocity of peak systolic (PSVBA), end diastolic (EDVBA), mean velocity (MFVBA), the depth (D) at the stenosis, the highest PSV of bilateral posterior cerebral arteries (PSVPCA) and intracranial segment of vertebral artery (PSVVA) were detected and recorded respectively. Depending on the findings of DSA, the receiver operating characteristic curve (ROC) was used to evaluated the sensitivity, specificity and accuracy for the PSVBA, EDVBA, MFVBA, PSVBA/PSVVA and PSVBA/PSVPCA. ResultsThe depth of proximal, middle and distal segment of basilar artery stenosis were detected at (90±5.4) mm, (97+3.0) mm, and (104+4.2) mm respectively. The best parameter of diagnostic criteria for the mild、middle and severe basilar artery stenosis were 110 cm/s≤PSVBA≤150 cm/s or 65 cm/s≤MFVBA≤90 cm/s, 150 cm/s≤PSVBA≤210 cm/s or 90 cm/s≤MFVBA≤135 cm/s and PSVBA≥210 cm/s or PSVBA/PSVVA≥3.5.ConclusionThe combination of TCD and TCCS, and choosing the <br> hemodynamic parameters of PSV, MFV and PSVBA/PSVVA , can better assess the basilar artery stenosis, especially for severe basilar artery stenosis.