对比增强TCD检查不同血管诊断右向左分流差异的比较
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摘要
目的比较对比增强TCD(c-TCD)检查左侧椎动脉(VA)与左侧大脑中动脉(MCA)诊断右向左分流(RLS)的差异。方法采用c-TCD对384例患者左侧VA及左侧MCA进行监测,比较二者RLS阳性率及程度的差异。结果静息时c-TCD检测左侧VA诊断RLS阳性率为35.68%,左侧MCA诊断RLS阳性率为35.42%,二者比较差异无统计学意义(P=1.00);以左侧MCA为标准,左侧VA监测的灵敏度为99.26%,特异度为99.19%,阳性预测值为98.54%,阴性预测值为99.19%,假阳性率为0.80%。Valsalva动作期间c-TCD检测左侧VA诊断RLS阳性率为58.33%,检测左侧MCA诊断RLS阳性率为58.59%,二者比较差异无统计学意义(P=1.00);以左侧MCA为标准,左侧VA监测的灵敏度为99.11%,特异度为99.37%,阳性预测值为99.55%,阴性预测值为94.04%,假阳性率为0.83%。Valsalva动作期间左侧VA监测和左侧MCA监测诊断RLS的程度差异无统计学意义(Z=0.021,P=0.983)。结论左侧VA监测与左侧MCA监测一样安全有效,可作为c-TCD检查RLS的替代方案。
Objective To compare the difference of right to left shunt(RLS) in left vertebral artery(VA) and left middle cerebral artery(MCA) diagnosed by contrast-enhanced TCD examination(c-TCD). Methods The left VA and left MCA were monitored by c-TCD at the same time in 384 patients. The positive rate and degree of the RLS was compared. Results When it is quiescent, the positive rate of the RLS in the left VA was 35.68% while in the left MCA was 35.42%. There was no significant difference in the positive rate between both(P=1.00). Take the left MCA as the standard, the sensitivity of the left VA was 99.26%, the specificity, the positive predictive value and the negative predictive value were 99.19%, 98.54% and 99.19%, the false positive rate was 0.80%. During the Valsalva action period, the positive rate of the RLS in the left VA was 58.33% while in the left MCA was 58.59%. There was no significant difference in the positive rate between both(P=1.00). Take the left MCA as the standard, the sensitivity of the left VA was 99.11%, the specificity, the positive predictive value and the negative predictive value were 99.37%, 99.55% and 94.04%, the false positive rate was 0.83%. During the Valsalva action period, there was no significant difference in the degree between both left VA and left MCA diagnosed by c-TCD(Z=0.021,P=0.983).Conclusion The left lateral VA monitoring is as effective and safety as the left MCA monitoring. It can be used as an alternative to RLS.
Objective To compare the difference of right to left shunt(RLS) in left vertebral artery(VA) and left middle cerebral artery(MCA) diagnosed by contrast-enhanced TCD examination(c-TCD). Methods The left VA and left MCA were monitored by c-TCD at the same time in 384 patients. The positive rate and degree of the RLS was compared. Results When it is quiescent, the positive rate of the RLS in the left VA was 35.68% while in the left MCA was 35.42%. There was no significant difference in the positive rate between both(P=1.00). Take the left MCA as the standard, the sensitivity of the left VA was 99.26%, the specificity, the positive predictive value and the negative predictive value were 99.19%, 98.54% and 99.19%, the false positive rate was 0.80%. During the Valsalva action period, the positive rate of the RLS in the left VA was 58.33% while in the left MCA was 58.59%. There was no significant difference in the positive rate between both(P=1.00). Take the left MCA as the standard, the sensitivity of the left VA was 99.11%, the specificity, the positive predictive value and the negative predictive value were 99.37%, 99.55% and 94.04%, the false positive rate was 0.83%. During the Valsalva action period, there was no significant difference in the degree between both left VA and left MCA diagnosed by c-TCD(Z=0.021,P=0.983).Conclusion The left lateral VA monitoring is as effective and safety as the left MCA monitoring. It can be used as an alternative to RLS.
引文
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[6] 郭雨竹,邢英琦.c-TCD超声诊断RLS相关问题探讨[J].中国卒中杂志,2016,11(7):515-530.
[7] Yang Y,Guo ZN,Wu J,et al.Prevalence and extent of right-to-left shunt in migraine:a survey of 217 Chinese patients[J].Eur J Neurol,2012,19(10):1367-1372.
[8] Kim B,Kim J,Kang NY,et al.Provoked right-to-left shunt in patent foramen ovale associates with ischemic stroke in posterior circulation[J].Stroke,2014,45(2):3707-3710.
[9] Mitsumura H,Sakuta K,Furuhata H,et al.Diagnosis of right-to-left shunt in intracranial vertebral artery by transcranial color flow imaging[J].Stroke,2012,31(3):2959-2963.
[10] Zhou M.Vertebral artery hypoplasia and vertebral artery dissection:a hospital-based cohort study[J].Neurology,2015,84(2):818-824.
[2] Pandit A,Aryal MR,Pandit AA,et al.Amplatzer PFO occlude device may prevent recurrent stroke in patients with patent foramen ovale and cryptogenic stroke:a meta-analysis of randomised trials[J].Heart Lung Circ,2014,23(5):303-308.
[3] Mojadidi MK,Roberts SC,Winoker JS,et al.Accuracy of transcranial doppler for the diagnosis of intracardiac Right-to-Left shunt a bivariate Meta-Analysis of prospective studies[J].JACC Cardiovasc Imaging,2014,7(3):236-250.
[4] 冯智英,邹静,华驾略,等.国际头痛疾患分类第3版(试用版)-原发性头痛部分解读[J].神经病学与神经康复学杂志,2013,10(2):121-140.
[5] 李瑶宣,周礼圆,伍广伟,等.体位在对比经颅多普勒超声检测卵圆孔未闭RLS中的影响[J].中华超声影像学杂志,2014,23(10):857-860.
[6] 郭雨竹,邢英琦.c-TCD超声诊断RLS相关问题探讨[J].中国卒中杂志,2016,11(7):515-530.
[7] Yang Y,Guo ZN,Wu J,et al.Prevalence and extent of right-to-left shunt in migraine:a survey of 217 Chinese patients[J].Eur J Neurol,2012,19(10):1367-1372.
[8] Kim B,Kim J,Kang NY,et al.Provoked right-to-left shunt in patent foramen ovale associates with ischemic stroke in posterior circulation[J].Stroke,2014,45(2):3707-3710.
[9] Mitsumura H,Sakuta K,Furuhata H,et al.Diagnosis of right-to-left shunt in intracranial vertebral artery by transcranial color flow imaging[J].Stroke,2012,31(3):2959-2963.
[10] Zhou M.Vertebral artery hypoplasia and vertebral artery dissection:a hospital-based cohort study[J].Neurology,2015,84(2):818-824.