Application Of 256-slice Spiral CT Angiography,Cervical Vascular Ultrasound And TCD In The Diagnosis Of Patient With Ischemic Cerebrovascular Disease

Objectives The diagnostic criteria of 256-slice spiral CT angiography(CTA)were used to analyze the consistency of neck vascular ultrasound and transcranial doppler(TCD)in the diagnosis of intracranial artery stenosis in patients with ischemic cerebrovascular disease,and to provide more comprehensive and accurate clinical diagnosis and treatment.Reference basis.Methods 132 patients with ischemic cerebrovascular disease admitted to the department of neurology of our hospital from November 2017 to March 2019 were selected.All patients were confirmed by cranial magnetic resonance imaging and their clinical manifestations met the diagnostic criteria for ischemic stroke(1996,revised edition)issued by the 4th national conference on cerebrovascular diseases.All patients were performed 256 layer spiral CT angiography(CTA),neck vascular ultrasonography and transcranial doppler(TCD)examination.Contrastive analysis of the consistency of cervical vascular ultrasound and CTA in the diagnosis of cervical vascular stenosis and degree of stenosis in patients with ischemic cerebrovascular disease and to observe the characteristics of neck plaques in patients with ischemic cerebrovascular disease.The consistency of TCD and CTA in the diagnosis of intracranial artery stenosis and degree of stenosis in patients with ischemic cerebrovascular disease was compared and analyzed,as well as the consistency of TCD and CTA in the diagnosis of different intracranial artery stenosis in patients with ischemic cerebrovascular disease.Results 1.In 132 patients with ischemic cerebrovascular disease,792 cervical arteries were examined,and CTA examination showed 144 narrow vessels.Using CTA as the standard for the diagnosis of vascular stenosis,the sensitivity and specificity of cervical vascular ultrasound in the diagnosis of cervical artery stenosis in 132 patients with ischemic cerebrovascular disease were calculated as 85.09%,98.38%,89.81%,97.51%,61.73,0.15 and 0.853,respectively.Using CTA as the standard for the diagnosis of vascular stenosis,the sensitivity and specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and Kappa value of cervical vascular ultrasound in the diagnosis of cervical artery stenosis of varying degrees in 132 patients with ischemic cerebrovascular disease were calculated.The results showed that the sensitivity,positive predictive value and Kappa value of cervical vascular ultrasound in the detection of severe extracranial vascular stenosis were the highest,and the positive likelihood ratio was > 10.2.There was no statistically significant difference between cervical vascular ultrasound and CTA in the diagnosis of carotid artery and internal carotid artery plaque in patients with ischemic cerebrovascular disease(P>0.05).Cervical vascular ultrasound and CTA showed statistically significant differences in the diagnosis of extracranial vertebral artery plaque in patients with ischemic cerebrovascular disease(P<0.05).There was no statistically significant difference between cervical vascular ultrasound and CTA in the diagnosis of soft plaques and mixed plaques in patients with ischemic cerebrovascular disease(P>0.05).There was a statistically significant difference between cervical vascular ultrasound and CTA in the diagnosis of calcified plaques in patients with ischemic cerebrovascular disease(P<0.05).3.1452 intracranial arteries were examined in 132 patients with ischemic cerebrovascular disease,and the CTA examination showed 244 narrow vessels.Using CTA as the standard for the diagnosis of vascular stenosis,the sensitivity and specificity of TCD in the diagnosis of intracranial artery stenosis in 132 patients with ischemic cerebrovascular disease were calculated as 83.61%,98.26%,90.67%,96.74%,48.05,0.17,and 0.745 Kappa values,respectively.CTA was used as the standard for the diagnosis of vascular stenosis,and the sensitivity and specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and Kappa value of TCD for intracranial artery stenosis in 132 patients with ischemic cerebrovascular disease were calculated.The results showed that TCD had the highest sensitivity,positive predictive value and Kappa value in the detection of severe intracranial vascular stenosis,and the positive likelihood ratio was > 10.4.Among the1452 intracranial artery stenosis examined in 132 patients with ischemic cerebrovascular disease,CTA was used as the diagnostic standard for vascular stenosis,and the sensitivity and specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and Kappa value of TCD for different intracranial artery stenosis in 132 patients with ischemic cerebrovascular disease were calculated.Among them,TCD has the highest sensitivity,positive predictive value and Kappa value for MCA,and the positive likelihood ratio is > 10.Conclusion 1.Cervical vascular ultrasound has a good consistency with CTA in the diagnosis of extracranial vascular stenosis in ischemic cerebrovascular disease,especially in severe extracranial vascular stenosis.2.The detection rate of extracranial vertebral artery plaque in patients with ischemic cerebrovascular disease by CTA is higher than that by cervical vascular ultrasound.The CTA detection rate of calcified plaques in patients with ischemic cerebrovascular disease is higher than that of cervical vascular ultrasound.3.TCD has a good consistency with CTA in the diagnosis of intracranial vascular stenosis in ischemic cerebrovascular disease,especially for severe intracranial vascular stenosis.4.TCD and CTA have the best consistency in the diagnosis of MCA stenosis in patients with ischemic cerebrovascular disease.