颈内动脉粥样硬化性狭窄与颅内血管狭窄的超声诊断研究

发布时间：2017-12-28 03:36

本文关键词：颈内动脉粥样硬化性狭窄与颅内血管狭窄的超声诊断研究　出处：《兰州大学》2016年硕士论文　论文类型：学位论文

【摘要】：第一部分分析不同标准的彩色多普勒血流成像(CDFI)诊断颈内动脉(ICA)粥样硬化性狭窄的价值目的:分析三种彩色多普勒(CDFI)参数标准(美国标准、澳大利亚标准和中国宣武标准)诊断颈内动脉(ICA)狭窄程度的敏感性、特异性,为客观评估颈动脉狭窄提供指导。方法:收集2013年9月~2015年11月就诊兰州大学第一医院、兰州军区兰州总医院、甘肃省人民医院怀疑存在ICA狭窄的患者73例,分别采用三种CDFI参数标准对ICA的狭窄程度进行评估;参照全脑数字减影血管造影(DSA)评估结果,分析三种参数标准对颈内动脉粥样硬化性狭窄(ICAS)的诊断价值。结果:三种血管狭窄评判标准结果与DSA检查结果对比分析,经一致性检验分析显示:三种参数标准的评估结果与DSA标准评估结果具有一致性,美国标准、澳大利亚标准和中国宣武标准的Kappa值分别为0.724、0.775、0.570,三种不同参数标准均具有统计学意义(P0.01);分析ROC曲线显示,澳大利亚标准对于中、重度狭窄的诊断敏感性(70.00%、85.33%)和特异性(97.11%、98.14%)最高。结论:CDFI三种参数标准均可有效地评估ICA狭窄程度,澳大利亚标准的中、重度ICAS的诊断有效性优于另外两种。第二部分超声造影对颅内血管狭窄性病变的诊断价值目的:比较分析常规经颅超声(TCD)和经颅超声血管造影(CE-TCD)对颅内血管狭窄性病变的诊断价值。方法:收集2013年9月~2015年11月就诊兰州大学第一医院、兰州军区兰州总医院、甘肃省人民医院可疑颅内血管狭窄病例90例,应用TCD、CE-TCD观察颅内Willis环及大脑前、中动脉,椎基底动脉的显示情况,记录分析造影前后的血流动力学参数。结果:1.CE-TCD对颅内动脉狭窄的显示率明显高于TCD,尤其表现在频谱分析;2.CE-TCD对血流动力学参数Vp、Vd、Vm和T的评估与TCD无明显差异(P0.05);3.参照CTA评估结果,TCD与CTA的诊断结果一致性较差(Kappa=0.119,P0.05),而CE-TCD与CTA诊断结果一致性较好(Kappa=0.668,P0.05)。结论:CE-TCD较TCD可显著提高颅内大动脉的显示率,并且可以通过图像的重建来提高血管狭窄程度评估的准确率,与CTA检查有较好一致性。
[Abstract]:The first part of the analysis of the different standards of the color Doppler flow imaging (CDFI) diagnosis of carotid atherosclerotic stenosis (ICA) objective: to analyze the value of three kinds of color Doppler parameters (CDFI) standard (American Standard, Australian standards and Xuanwu Chinese standard) (ICA) in the diagnosis of carotid artery stenosis degree of sensitivity and specificity, provide guidance for objective assessment of carotid artery stenosis. Methods: from September 2013 November in First Hospital Affiliated to Lanzhou University, ~2015 Lanzhou General Hospital of Lanzhou military command, Gansu Provincial People's Hospital, 73 cases of suspected ICA stenosis patients, respectively, by three CDFI standard parameters to evaluate ICA stenosis; reference DSA (DSA) assessment results, analysis of three kinds of standard parameters of the internal carotid atherosclerotic stenosis (ICAS) diagnostic value. Results: the comparative analysis of three kinds of vascular stenosis evaluation standard results and DSA results, the consistency test analysis showed that the three parameters standard evaluation results and evaluation results consistent with the DSA standard, American Standard, Australian standards and China Xuanwu standard Kappa value of 0.724, 0.775, 0.570, three kinds of different parameters the standard was statistically significant (P0.01); analysis of ROC curves showed that the Australian standard for severe stenosis, the diagnostic sensitivity (70%, 85.33%) and specificity (97.11%, 98.14%) highest. Conclusion: the three parameters of CDFI can effectively evaluate the degree of ICA stenosis, and the diagnostic effectiveness of moderate and severe ICAS in Australia is better than that of the other two. The second part is the diagnostic value of contrast-enhanced ultrasound in intracranial stenosis. Objective: To compare the diagnostic value of conventional transcranial ultrasound (TCD) and transcranial ultrasound angiography (CE-TCD) for intracranial vascular stenosis. Methods: from September 2013 November in First Hospital Affiliated to Lanzhou University, ~2015 Lanzhou General Hospital of Lanzhou military command, Gansu Provincial People's Hospital suspected of intracranial vascular stenosis in 90 cases, the application of TCD, CE-TCD and Willis ring observation of intracranial anterior and middle cerebral artery, show the situation of vertebrobasilar artery and hemodynamic parameters were recorded and analyzed before and after contrast. Results: 1.CE-TCD of intracranial artery stenosis that was significantly higher than that of TCD, especially in spectrum analysis; no significant difference between the assessment and TCD 2.CE-TCD on hemodynamic parameters of Vp, Vd, Vm and T (P0.05); 3. according to CTA assessment results, the diagnosis of TCD and CTA were poor consistency (Kappa=0.119, P0.05). CE-TCD and CTA diagnosis results are in good agreement (Kappa=0.668, P0.05). Conclusion: compared with TCD, CE-TCD can significantly improve the display rate of intracranial large artery, and can improve the accuracy of evaluation of vascular stenosis by image reconstruction, which is in good agreement with CTA.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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