首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (4): 694-701.doi: 10.3969/j.issn.1006-7795.2025.04.017

• 临床研究 • 上一篇    下一篇

经颅彩色多普勒超声联合经颅超声造影与磁共振血管成像在颅内动脉狭窄诊断中的相关性及应用价值

夏岩1,王嵘2,张蕾3,林发2,刘子琪2,王晓岩1*   

  1. 1.首都医科大学附属北京天坛医院医务处，北京 100070；2.首都医科大学附属北京天坛医院神经外科学中心，北京 100070；3.首都医科大学附属北京天坛医院超声科，北京 100070
  • 收稿日期:2025-04-07 出版日期:2025-08-21 发布日期:2025-09-01
  • 通讯作者: 王晓岩 E-mail:ttyyywc@126.com
  • 基金资助:
    国家重点研发计划项目（2021YFC2501101），首都医科大学附属北京天坛医院院科研基金（管理专项）项目（TYGL202412），首都卫生发展科研专项项目（CFH-2022-3-1056）。

The correlation and application value of transcranial color-code Duplex ultrasound combined with contrast-enhanced ultrasound and magnetic resonance angiography in the diagnosis of intracranial arterial stenosis

Xia Yan1, Wang Rong2, Zhang Lei3, Lin Fa2, Liu Ziqi2, Wang Xiaoyan1*    

  1. 1.Medical Affairs Office, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2025-04-07 Online:2025-08-21 Published:2025-09-01
  • Supported by:
    This study was supported by National Key Research and Development Project of China（2021YFC2501101）, Funded Project of Beijing Tiantan Hospital, Capital Medical University Research Fund (Management Special Fund) （TYGL202412）, Capital' s Funds for Health Improvement and Research (CFH-2022-3-1056) .

PDF

3

摘要： 目的  探究经颅彩色多普勒超声（transcranial color-coded Duplex ultrasound, TCCD）联合超声造影（contrast-enhanced ultrasound, CEUS）检测颅内主要动脉狭窄的灵敏度、特异度及其与磁共振血管成像（magnetic resonance angiography, MRA）检查结果的一致性和应用价值。方法  选取2023年4月至2024年8月首都医科大学附属北京天坛医院医院55例疑似颅内动脉狭窄或闭塞患者，分别应用TCCD联合CEUS和MRA，检查颈内动脉终末段、大脑中动脉M1和M2段，大脑前动脉A1和A2段、大脑后动脉P1和P2段以及椎动脉V4段等血管狭窄程度。将颅内动脉狭窄程度分为正常/轻度、中度、重度/闭塞3组，计算两种检查方法的灵敏度、特异度及一致性。采用Wilcoxon符号秩检验比较两种检查费用及诊断时长的差异。结果  本研究纳入55例（共110例大脑半球）高危脑血管狭窄患者（中位年龄46岁，男性占69.0%），同步行TCCD联合CEUS与MRA检测。TCCD联合CEUS与MRA在颅内动脉狭窄诊断的灵敏度和特异度较高。TCCD联合CEUS与MRA在诊断颅内动脉狭窄具有一致性，其中M2段（加权Kappa值=0.704）、A2段（加权Kappa值=0.650）诊断一致性较高；M1段（加权Kappa值=0.569）一致性中等。同时，TCCD联合CEUS检查的平均费用为240元，诊断时长21 min，而MRA为722元和287 min（P<0.001，效应量r=0.89~0.91）。结论  与MRA相比，TCCD联合CEUS在颅内大脑中动脉M2段和大脑前动脉A2段的血管狭窄筛查中具有较高一致性。TCCD联合CEUS更具成本效益。MRA对颅内深部血管狭窄程度的评估更具有优势。选择二者协同应用可优化颅内血管狭窄诊疗资源配置，建议基层医疗机构以TCCD初筛和经过规范培训技术升级联合CEUS，对复杂病例转诊MRA精细化评估。

关键词: 经颅彩色多普勒超声, 超声造影, 磁共振血管成像, 颅内动脉, 卫生经济学, 诊疗模式

Abstract: Objective  Magnetic resonance angiography (MRA) offers a non-invasive and radiation-free advantage in detecting and diagnosing intracranial artery stenosis; however, it is associated with high equipment costs. Transcranial color-coded Duplex ultrasound (TCCD) combined with contrast-enhanced ultrasound (CEUS) presents advantages such as non-invasiveness, real-time dynamic monitoring, and low cost. Nevertheless, there were no reports comparing the sensitivity, specificity, diagnostic agreement with MRA, or health economic evaluation of TCCD combined with CEUS for detecting major intracranial artery stenosis. Methods  From April 2023 to August 2024, a total of 55 patients suspected of having intracranial artery stenosis or occlusion were recruited at Beijing Tiantan Hospital, Capital Medical University. Both TCCD combined with CEUS and MRA were performed to evaluate the degree of stenosis in the terminal segment of the internal carotid artery, M1 and M2 segments of the middle cerebral artery, A1 and A2 segments of the anterior cerebral artery, P1 and P2 segments of the posterior cerebral artery, and the V4 segment of the vertebral artery. Intracranial artery stenosis was categorized into three groups: normal/mild, moderate, and severe/occlusion. Sensitivity, specificity, and consistency between the two methods were calculated. The Wilcoxon signed-rank test was used to compare the differences in examination costs and diagnostic time. Results  Fifty-five high-risk patients (110 cerebral hemispheres in total) with suspected cerebrovascular stenosis were included (median age: 46 years; 69.0% male). TCCD combined with CEUS and MRA were performed simultaneously. TCCD combined with CEUS showed high sensitivity and specificity in diagnosing intracranial artery stenosis, with good consistency compared to MRA. The highest diagnostic consistency was observed in the M2 segment (Kappa=0.704) and A2 segment (Kappa=0.650), while the M1 segment showed moderate consistency (Kappa=0.569). The average cost of TCCD combined with CEUS was 240 CNY with a diagnostic duration of 21 min, compared to 722 CNY and 287 min for MRA (P<0.001, effect sizer=0.89 － 0.91). Conclusion  Compared to MRA, TCCD combined with CEUS demonstrates higher consistency in screening for stenosis in the M2 segment of the middle cerebral artery and the A2 segment of the anterior cerebral artery. It is also more cost-effective. However, MRA has advantages in assessing deep intracranial vessels. A synergistic use of both methods can optimize the allocation of diagnostic resources for intracranial artery stenosis. It is recommended that primary healthcare institutions adopt TCCD as the initial screening tool, and, with standardized training and technical upgrades, combine it with CEUS. Complex cases should be referred for detailed evaluation by using MRA.

Key words: transcranial color-coded Duplex ultrasound, contrast-enhanced ultrasound, magnetic resonance angiography, intracranial arteries, health economics, treatment model

中图分类号: 

网站版权所有 © 《首都医科大学学报》编辑部
地址：北京市丰台区右安门外西头条10号　邮编：100069
电话：010-83911346　 Email：xuebao@ccmu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发　技术支持：support@magtech.com.cn
京ICP备10013688号-1