CAJ | 학술논문

目的：探讨经颅彩色多普勒超声（TCCS）诊断颅内段椎动脉狭窄的血流动力学参数标准。方法回顾性纳入622例门诊或住院可疑后循环缺血患者，从中选取经TCCS、彩色多普勒血流显像（CDFI）筛查和DSA检查的患者共216例，其中颅内椎动脉正常者33例（15.3％），狭窄率＜50％者45例（20.8％），狭窄率为50％～69％者44例（20.4％），狭窄率为70％～99％者94例（43.5％）。通过检测颅内段椎动脉、椎间隙段收缩期峰值流速（PSV1、PSV2）和舒张期末流速（EDV1、EDV2），分别计算颅内段平均流速（MV）、颅内段与椎间隙段收缩期峰值流速、舒张期末流速的比值SPRP （PSV1／PSV2）、SPRE （EDV1／EDV2）。以 DSA检查结果为标准，计算受试者工作特征（ROC）曲线下面积，获得最佳截断点。结果 TCCS诊断颅内段椎动脉狭窄血流动力学参数最佳截断点分别为：狭窄率＜50％的参数标准为110 cm／s≤PSV1≤145 cm／s，65 cm／s≤MV≤85 cm／s；狭窄率为50％～69％的参数标准为145 cm／s≤PSV1≤190 cm／s，85 cm／s≤MV≤115 cm／s；狭窄率为70％～99％的参数标准为 PSV1≥190 cm／s，MV≥115 cm／s。结论 TCCS可有效评价颅内段椎动脉狭窄的血流动力学变化，为颅内段椎动脉狭窄的超声评判标准提供参考。
목적：탐토경로채색다보륵초성（TCCS）진단로내단추동맥협착적혈류동역학삼수표준。방법회고성납입622례문진혹주원가의후순배결혈환자，종중선취경TCCS、채색다보륵혈류현상（CDFI）사사화DSA검사적환자공216례，기중로내추동맥정상자33례（15.3％），협착솔＜50％자45례（20.8％），협착솔위50％～69％자44례（20.4％），협착솔위70％～99％자94례（43.5％）。통과검측로내단추동맥、추간극단수축기봉치류속（PSV1、PSV2）화서장기말류속（EDV1、EDV2），분별계산로내단평균류속（MV）、로내단여추간극단수축기봉치류속、서장기말류속적비치SPRP （PSV1／PSV2）、SPRE （EDV1／EDV2）。이 DSA검사결과위표준，계산수시자공작특정（ROC）곡선하면적，획득최가절단점。결과 TCCS진단로내단추동맥협착혈류동역학삼수최가절단점분별위：협착솔＜50％적삼수표준위110 cm／s≤PSV1≤145 cm／s，65 cm／s≤MV≤85 cm／s；협착솔위50％～69％적삼수표준위145 cm／s≤PSV1≤190 cm／s，85 cm／s≤MV≤115 cm／s；협착솔위70％～99％적삼수표준위 PSV1≥190 cm／s，MV≥115 cm／s。결론 TCCS가유효평개로내단추동맥협착적혈류동역학변화，위로내단추동맥협착적초성평판표준제공삼고。
Objective To investigate the criteria of hemodynamic parameters for diagnosis of intracranial segment vertebral artery stenosis with transcranial color-coded sonography (TCCS ). Methods A total of 622 outpatients or inpatients with suspected posterior circulation ischemia were enrolled retrospectively,from which 216 patients were selected with TCCS,color Doppler flow imaging (CDFI)screen,and digital subtraction angiography (DSA)examination,including 33 patients (15. 3%) had normal intracranial vertebral arteries,the stenosis rates<50% were 45 cases (20. 8%),50%-69%were 44 cases (20. 4%),and 70%-99% were 94 cases (43. 5%). The mean velocity (MV)of intracranial segment,the ratios SPRP (PSV1/PSV2 ),SPRE (EDV1/EDV2 )of the systolic and end diastolic flow velocity between the intracranial segment and the intervertebral space segment were calculated respectively by detecting the intracranial segment of vertebral artery,the intervertebral space segment peak systolic velocity (PSV1 ,PSV2 )and end diastolic velocity (EDV2 ,EDV1 ). The DSA findings were used as the criteria,the area under the receiver operating characteristic (ROC ) curve was calculated and the optimal cut-off points were obtained. Results The optimal cut-off points of TCCS diagnosis of intracranial vertebral artery stenosis were as follows:the parameter standards of stenosis rate <50% were 110 cm/s≤PSV1≤145 cm/s and 65 cm/s≤MV≤85 cm/s,the parameter standards of stenosis rate 50%-69%were 145 cm/s≤PSV1≤190 cm/s and 85 cm/s≤MV≤115 cm/s,and the parameter standards of stenosis rate 70%-99% were PSV1≥190 cm/s and MV≥115 cm/s. Conclusion TCCS may effectively evaluate the hemodynamic changes of intracranial vertebral artery stenosis and provide reference for the ultrasound evaluation criteria of intracranial vertebral artery stenosis.