本文關(guān)鍵詞：頸內(nèi)動(dòng)脈粥樣硬化性狹窄與顱內(nèi)血管狹窄的超聲診斷研究　出處：《蘭州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 彩色多普勒 頸內(nèi)動(dòng)脈 狹窄 顱內(nèi)血管 超聲多普勒 造影 診斷

【摘要】：第一部分分析不同標(biāo)準(zhǔn)的彩色多普勒血流成像(CDFI)診斷頸內(nèi)動(dòng)脈(ICA)粥樣硬化性狹窄的價(jià)值目的:分析三種彩色多普勒(CDFI)參數(shù)標(biāo)準(zhǔn)(美國(guó)標(biāo)準(zhǔn)、澳大利亞標(biāo)準(zhǔn)和中國(guó)宣武標(biāo)準(zhǔn))診斷頸內(nèi)動(dòng)脈(ICA)狹窄程度的敏感性、特異性,為客觀評(píng)估頸動(dòng)脈狹窄提供指導(dǎo)。方法:收集2013年9月~2015年11月就診蘭州大學(xué)第一醫(yī)院、蘭州軍區(qū)蘭州總醫(yī)院、甘肅省人民醫(yī)院懷疑存在ICA狹窄的患者73例,分別采用三種CDFI參數(shù)標(biāo)準(zhǔn)對(duì)ICA的狹窄程度進(jìn)行評(píng)估;參照全腦數(shù)字減影血管造影(DSA)評(píng)估結(jié)果,分析三種參數(shù)標(biāo)準(zhǔn)對(duì)頸內(nèi)動(dòng)脈粥樣硬化性狹窄(ICAS)的診斷價(jià)值。結(jié)果:三種血管狹窄評(píng)判標(biāo)準(zhǔn)結(jié)果與DSA檢查結(jié)果對(duì)比分析,經(jīng)一致性檢驗(yàn)分析顯示:三種參數(shù)標(biāo)準(zhǔn)的評(píng)估結(jié)果與DSA標(biāo)準(zhǔn)評(píng)估結(jié)果具有一致性,美國(guó)標(biāo)準(zhǔn)、澳大利亞標(biāo)準(zhǔn)和中國(guó)宣武標(biāo)準(zhǔn)的Kappa值分別為0.724、0.775、0.570,三種不同參數(shù)標(biāo)準(zhǔn)均具有統(tǒng)計(jì)學(xué)意義(P0.01);分析ROC曲線顯示,澳大利亞標(biāo)準(zhǔn)對(duì)于中、重度狹窄的診斷敏感性(70.00%、85.33%)和特異性(97.11%、98.14%)最高。結(jié)論:CDFI三種參數(shù)標(biāo)準(zhǔn)均可有效地評(píng)估ICA狹窄程度,澳大利亞標(biāo)準(zhǔn)的中、重度ICAS的診斷有效性優(yōu)于另外兩種。第二部分超聲造影對(duì)顱內(nèi)血管狹窄性病變的診斷價(jià)值目的:比較分析常規(guī)經(jīng)顱超聲(TCD)和經(jīng)顱超聲血管造影(CE-TCD)對(duì)顱內(nèi)血管狹窄性病變的診斷價(jià)值。方法:收集2013年9月~2015年11月就診蘭州大學(xué)第一醫(yī)院、蘭州軍區(qū)蘭州總醫(yī)院、甘肅省人民醫(yī)院可疑顱內(nèi)血管狹窄病例90例,應(yīng)用TCD、CE-TCD觀察顱內(nèi)Willis環(huán)及大腦前、中動(dòng)脈,椎基底動(dòng)脈的顯示情況,記錄分析造影前后的血流動(dòng)力學(xué)參數(shù)。結(jié)果:1.CE-TCD對(duì)顱內(nèi)動(dòng)脈狹窄的顯示率明顯高于TCD,尤其表現(xiàn)在頻譜分析;2.CE-TCD對(duì)血流動(dòng)力學(xué)參數(shù)Vp、Vd、Vm和T的評(píng)估與TCD無(wú)明顯差異(P0.05);3.參照CTA評(píng)估結(jié)果,TCD與CTA的診斷結(jié)果一致性較差(Kappa=0.119,P0.05),而CE-TCD與CTA診斷結(jié)果一致性較好(Kappa=0.668,P0.05)。結(jié)論:CE-TCD較TCD可顯著提高顱內(nèi)大動(dòng)脈的顯示率,并且可以通過圖像的重建來(lái)提高血管狹窄程度評(píng)估的準(zhǔn)確率,與CTA檢查有較好一致性。
[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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.3

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