The Comparative Study Of TCD And DSA In The Diagnosis Of Cerebralischemic Stroke

Background and ObjectiveCerebrovascular disease is well known for its high morbidity and mortality rate. With ageing population increase and the changing of the diet, the incidence of the ischemic cerebrovascular disease keeps rising, which has an enormous impact on the life quality of the elderly. Nowadays the early diagnose of cerebrovascular disease has become a heated topic. By revealing the region and degree of the cerebral blood artery stenosis accurately in early stage, we can take treatment measures effectively. It is of great significance in lowering the incidence and recurrence rate of the ischemic cerebrovascular disease. Currently, digital subtraction angiography(DSA) is still the gold standard in diagnosing ischemic cerebrovascular disease. But as the examination being invasive and expensive, it is not acceptable to some patients. Transcranial Doppler ultrasound (TCD) is a non-invasive and efficient intracranial blood vessels screening technique, and has been widely used in clinical practice. Researches of TCD both domestic and abroad have controversial results on the accuracy of the cerebral blood artery stenosis rate. Leading to the doubt among physicians of TCD of its reliability in diagnosing cerebral blood artery stenosis with TCD examination. Therefore, by reviewing experience and results of the past researches, We make analyse of the diagnostic value with the application of TCD in our Medical center. Furthermore, there's too few research on syndrome differ classification of traditional chinese medicine and modern image in stroke. Takeing DSA findings as the standard, by investigating the clinical diagnostic value of TCD in diagnosing different Chinese syndromes of the ischemic stroke, hopefully, it may for provide reference to future clinical treatment of the disease. PARTⅠObjectiveTo analyses the difference between transcranial Doppler(TCD) and digital subtraction angiography(DSA) in diagnosing of patients with ischemic cerebrovascular stenosis in our medical center, between January 2005 and October 2009.MethodsThe data of TCD and DSA were analyzed retrospectively in 270 patient with ischemic cerebrovascular attack, and the results of DSA were then compared with those of TCD.Results①149 patients were included from January 2007 to October 2009, the sensitivity, specificity, positive and negative predictive value of TCD were 56.3%,87.7%,42.9%,92.4%.②121 patients were included from January 2005 to December 2006, the sensitivity, specificity, positive and negative predictive value of TCD were 40.1%,83.4%,23.7%,91.5%.③A total of 2970 arteries in 270 patients were examined. By comparing with the DSA results, the sensitivity, specificity, positive predictive value and negative predictive value of TCD were 49.9%,85.5%,34.1%,92%, respectively.ConclusionTCD can be applied as an preliminary screening examination for the evaluation of cerebral artery in patients with ischemic cerebrovascular disease. The sensitivity, specificity of the results were lower than the DSA. It's result mad as one of important basis of clinical diagnosis.PARTⅡObjectiveTo analyze the result of TCD in different parts and degrees of cerebral blood artery. To analyze the characteristics of stenosis in responsible artery in patients with ischemic cerebrovascular disease. To study the compensatory way by collateral circulation in ischemic stroke cases.Methods①149 cases admitted between January 2007 and October 2009 of ischemis cerebrovascular disease were included in this study. Taking the DSA results as the standard, the sensitivity, specificity, accuracy, positive, and negative predictive value for diagnosing different part and vascular stenosis by TCD were analyzed.②To analyse the sensitivity, specificity of bilateral vessels by the receiver operating characteristic curve (ROC curve). To analyze the influent factors of diagnosis experience using Logistic regression.③To assess the collateral circulation and guilty artery in 149 patients with ischemic cerebrovascular disease according to DSA results.Results①The most common site of stenosis in cerebrovasculars was VA, following by MCA,ICA. The incidence of cerebrovascular stenosis were significantly higher in the left hemisphere, (P<0.05).②TCD had the higher sensitivity and specificity in diagnosing MCA stenosis, especially the left MCA revealed by the ROC curve, (P<0.05).③The sensitivity and specificity in diagnosing severe stenosis by TCD were significanly higher, (P<0.05).④The influent factors about the test sensitivity of TCD included age,individual operations and clinical syndrome type. The operator experience was considered as the main influencing factors.⑤In those 149 patients between January 2007 and October 2009,134(89.7%) had cerebral artery stenosis or occlusion diagnosed by DSA, while TCD reveal 94(63.1%). MCA had the highest incidence to be the responsible artery in 130 cases, which was identified by DSA.⑥Taking the DSA findings as the standard, There were 45(30.2%) cases had collateral circulation, compare with 26(17.4%) diagnosed by TCD, and the sensitivity and specificity of TCD were 40%,92.3%, respectively. The incidence of collateral circulation compensation in ICA stenosis or occlusion cases, and it was higher that in others. However, the circle of Willis compensation is more common in ICA occlusion cases, and the pia collateral compensation is more common in MCA and ACA stenosis or occlusion.Conclusion ①The occurrence of left hemisphere cerebral artery stenosis or occlusion in patients with ischemic cerebrovascular disease is more common, and VA has the highest incidence.②TCD had more accurate in diagnosing MCA stenosis than in others. The accuracy of diagnosis significantly rely on individual operators.③TCD had the higher sensitivity and specificity for diagnosis of severe artery stenosis.④The incidence of collateral circulation compensation is more common in ICA stenosis or occlusion, the circle of Willis compensation is most common in ICA, and the pia collateral compensation is more common in MCA, the diversity of compensation in cases VA stenosis or occlusion.PARTⅢObjectiveTo analyze the clinical diagnostic value of syndrome differentiation in patients with ischemic stroke in TCD and DSA.MethodsWe retrospectively analyzes the DSA and TCD data of 149 patients with ischemic stroke. take DSA as standard, discusses the sensitivity, specificity, positive predictive value and negative predictive value of TCD on ischemic stroke with different syndromes.ResultsIn 149 patients with ischemic stroke, (50.3%) of them belong to types of "wind, fire, phlegm and bloodstasis, and obstruction of meridian and collaterls"; next, "liver yang hyperactivity and wind-fire disturbing the upper" (24.8%). TCD on ischemic stroke with "liver yang hyperactivity "and "wind-fire disturbing the upper" has sensitivity (67.9% the highest) and specificity (88.3%); on "qi-deficiency bloodstasis" has sensitivity(61.5 %) and specificity(90.3% the highest). There is no statistical significance in diagnostic index with different syndromes.Conclusion Mostly, patients with ischemic cerebrovascular diseases are "wind-phlegm and bloodstasis, meridian and collaterls". Phlegm stagnation is the main reason for onset of patients with ischemic cerebrovascular diseases. In the treatment of ischemic cerebrovascular diseases, the application of related theory of phlegm stagnation has great significance, which can improve both the Chinese-western treatments and the clinical effect. Stroke with syndrome differentiation has no major influence on TCD test results. TCD has higher sensitivity in patients with "liver yang hyperactivity and wind-fire disturbing the upper", second to those of "qi-deficiency bloodstasis".Yet, no sifnificance difference has been revealed between the variables.