CAJ | 학술논문

目的：探讨彩色多普勒血流显像（CDFI）和经颅彩色多普勒超声（TCCS）联合检测评价颅内段椎动脉（IVA）重度狭窄支架置入治疗前后及再狭窄的血流动力学变化及其临床价值。方法回顾性纳入2011年11月至2013年11月经CDFI和TCCS联合检测并行全脑DSA证实的IVA重度狭窄患者102例，比较支架治疗前、术后1周及术后3、6、12个月椎动脉颅内、颅外段收缩期峰值流速（PSV）、舒张期末流速（EDV）、IVA搏动指数（PI）及颅外段阻力指数（RI）、管径、频谱形态和血流动力学参数。根据随访12个月时TCCS结果，将患者进一步分为再狭窄组（16例）和无再狭窄组（86例）。结果（1）TCCS检测显示，支架置入术后1周狭窄段的PSV、EDV、PI较术前明显改善，分别为（109±40）比（258±63）cm／s、（47±18）比（132±45）cm／s、0.91±0.15比0.75±0.18，差异均有统计学意义（均P＜0.01）。再狭窄组的PSV、EDV在术后3～12个月逐渐升高，术后12个月与术后1周比较，差异均有统计学意义（均P＜0.01）；无再狭窄组的PSV、EDV在术后12个月与术后1周比较，差异无统计学意义（P＞0.05）。（2）CDFI检测显示，术后1周患侧颅外段的PSV、EDV较术前明显改善，分别为（64±15）cm／s比（51±15）cm／s、（24±6）cm／s比（19±7）cm／s（均P＜0.01），RI值和颅外段椎动脉管径逐渐改善，于术后12个月时达到最高[0.61±0.07比0.63±0.12，P＝0.038；（3.6±0.4）mm比（3.4±0.5）mm，P＝0.009]。结论 CDFI与TCCS的联合应用可以客观评价IVA支架置入术前、术后颅外段及颅内段的血流动力学变化，为支架置入的有效性和再狭窄的影像学评估提供参考信息。
목적：탐토채색다보륵혈류현상（CDFI）화경로채색다보륵초성（TCCS）연합검측평개로내단추동맥（IVA）중도협착지가치입치료전후급재협착적혈류동역학변화급기림상개치。방법회고성납입2011년11월지2013년11월경CDFI화TCCS연합검측병행전뇌DSA증실적IVA중도협착환자102례，비교지가치료전、술후1주급술후3、6、12개월추동맥로내、로외단수축기봉치류속（PSV）、서장기말류속（EDV）、IVA박동지수（PI）급로외단조력지수（RI）、관경、빈보형태화혈류동역학삼수。근거수방12개월시TCCS결과，장환자진일보분위재협착조（16례）화무재협착조（86례）。결과（1）TCCS검측현시，지가치입술후1주협착단적PSV、EDV、PI교술전명현개선，분별위（109±40）비（258±63）cm／s、（47±18）비（132±45）cm／s、0.91±0.15비0.75±0.18，차이균유통계학의의（균P＜0.01）。재협착조적PSV、EDV재술후3～12개월축점승고，술후12개월여술후1주비교，차이균유통계학의의（균P＜0.01）；무재협착조적PSV、EDV재술후12개월여술후1주비교，차이무통계학의의（P＞0.05）。（2）CDFI검측현시，술후1주환측로외단적PSV、EDV교술전명현개선，분별위（64±15）cm／s비（51±15）cm／s、（24±6）cm／s비（19±7）cm／s（균P＜0.01），RI치화로외단추동맥관경축점개선，우술후12개월시체도최고[0.61±0.07비0.63±0.12，P＝0.038；（3.6±0.4）mm비（3.4±0.5）mm，P＝0.009]。결론 CDFI여TCCS적연합응용가이객관평개IVA지가치입술전、술후로외단급로내단적혈류동역학변화，위지가치입적유효성화재협착적영상학평고제공삼고신식。
Objective To investigate color Doppler flow imaging (CDFI)and transcranial color-coded sonography (TCCS)for detection and evaluation of severe stenosis of intracranial vertebral artery (IVA) before and after stenting,as well as the hemodynamic changes of restenosis and their clinical value. Methods A total of 102 patients with severe stenosis of IVA confirmed by CDFI plus TCCS and DSA from November 2011 to November 2013 were analyzed retrospectively. Extra- and intracranial segments peak systolic velocity (PSV),end-diastolic velocity (EDV),IVA pulsatility index (PI),extracranial resistance index (RI),tube diameter,spectrum morphology,and hemodynamic parameters before stenting and 1 week, 3,6 and 12 months after stenting were compared. According to the results of TCCS,they were further divided into either a restnosis group (n=16 )or a non-restnosis group (n=86 ). Results (1 )The results of TCCS detection showed:PSV,EDV,and PI of the stenotic segments were improved significantly at 1 week after stenting,they were 109 ± 40 cm/s vs. 258 ± 63 cm/s,47 ± 18 cm/s vs. 132 ± 45 cm/s,0. 91 ± 0. 15 vs. 0.75 ± 0. 18,respectively. There were significant differences (all P<0. 01). PSV and EDV of the restenosis group were increased gradually from 3 to 12 months after procedure. There were significant differences between 12 months after procedure and one week after procedure (all P<0. 01). There were no significant differences in PSV,EDV,and PI of the non-restenosis group between the 12-month observation period after procedure and one week after procedure (P>0. 05). (2)The results of CDFI showed:PSV and EDV of the ipsilateral extracranial segment were improved significantly after procedure compare with those before procedure, they were 64 ± 15 cm/s vs. 51 ± 15 cm/s and 24 ± 6 cm/s vs. 19 ± 7 cm/s (all P<0. 05). The RI value and vertebral artery diameter of the extracranial segment were improved gradually,and they reached the peak at 12 months after procedure (0. 61 ± 0. 07 vs. 0. 63 ± 0. 12,P=0. 038;3. 6 ± 0. 4 mm vs. 3. 4 ± 0.5 mm,P=0. 009). Conclusion CDFI in combination with TCCS can objectively evaluate the extra-and intracranial hemodynamic changes before and after IVA stenting,and provide reference information for the effectiveness of stenting and the imaging evaluation of restenosis.