| Objective: Stroke is one of the three killers threating the safty of human beings. There are about 440 millions of people died of cerebrovascular disease every year in all of the world. In China, there are about 100 millions of people died of this disease, in which about 2/3 of cases died because of arteriosclerosis. Many patients with ischemic stroke have intra-or extra-cranial arteriostenosis. The distribution of cerebrovascular stenosis has difference in race, the chance of intracranial arteriostenosis is apparently higher than extracranial arteriostenosis in Chinese people. With the recent development and research in the interventional treatment for cerebral arteriostenosis, how to detect the stenosis quickly, conveniently and safely is still the aim of the clinical doctors. Color Doppler sonography (including CDFI and TCD) is becoming the first choice for its convenience, no trauma and no radiation, but what we concern is Doppler sonography's reliability because display and judgement of its image is excessively dependent on examiner's skill and experimence. The purpose of this study is to evaluate sonography's diagnostic value for cerebral arteriostenosis in patients with symptomatic intra-or extra-cranial stenosis according to the results of CDFI and TCD compared with DSA, and to observe the occurrence ratio of intra-and extra-cranial cerebral arteriostenosis. Methods: The data were from Xuanwu hospital of Capital Medical University. We selected a group of patients with ischemic stroke confirmed by clinical and imaging examination (mainly MRI) in the period of Feb. to July in 2004 (135 men and 50 women,age range 22~81years, mean age 56+7.9 years). All the patients had one or more cerebral arteriostenosis identified by DSA.The patients were all examined by colorful Doppler flowing image (CDFI) used at carotid arteries and transcranial Doppler (TCD) used at intracranial arteries before or after DSA.The mean interval time between sonography and DSA was 2.9+2 days (0~7days). According to the diagnostic standards, the degrees of vascular stenosis were divided into mild (stenosis<50%), moderate (50%~69%), severe (70%~99%) and occluded (100%). The cerebral arteries were also divided into accordant segments to make the results of sonography comparable with angiography. Internal carotid artery (ICA) was quinquepartite: terminal segment (tICA), siphon segment (sICA), petrous segment (pICA), ascending segment (aICA) and bulb part (bICA). Vertebral artery (VA) was tripartite:orifice part (oVA), cervical ascending segment (aVA) and intracranial segment (iVA). In term of conventional method of subsection, anterior cerebral artery (ACA) included A1 and A2~5, middle cerebralartery (MCA) included M1 and M2~5, posterior cerebral artery (PCA) included P1 and P2~5 respectively.The results were analysed by SPSS 12.0 software. The results of sonography and angiography were tested by Chi-square test, the degree of stenosis obtained by two methods were tested by ordinal by ordinal spearman correlation test. The difference among ratios were also tested by Chi-square. Regarding the results of DSA as gold standard, we calculated the sonography's sensitivity (Sens.), specificity(Spec.), accuracy (Accu.), positive predictive value(PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Results: ⑴The following in decreasing sequence was the amounts of the cerebral arteriostenosis in different parts of cerebral arteries among 185 patients with ischemic stroke according to the results of DSA: bICA 145(39.2%), oVA 98(26.5%), MCA-M1 72(19.5%), Sica 67(18.1%), BA 26(14.1%), iVA 44(11.9%), aICA 31(8.4%), pICA 22(5.9%), tICA 20(5.4%), PCA-P1 16(4.3%), ACA-A1 13(3.5%), aVA 9(2.4%). Of the 185 patients, 97 cases(58.5%) were diagnosed as having extracranial cerebral arteriostenosis, 126 cases(68.1%) were diagnosed as having intracranial cerebral arteriostenosis, and 38 cases(20.5%) were diagnosed as having extra-and intra-cranial cerebral arteriostenosis. ⑵The CDFI used at examining extracra... |
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