目的：探讨经颅多普勒超声（TCD）或经颅彩色多普勒超声（TCCS）联合评估基底动脉狭窄性病变的血流动力学参数标准及准确性。方法连续纳入2012年6月至2014年6月首都医科大学宣武医院同期进行TCD及TCCS检测，并经过数字减影血管造影（DSA）证实的基底动脉狭窄患者261例，记录基底动脉狭窄患者基底动脉收缩期峰值流速（PSVBA）、舒张末期流速（EDVBA）与平均流速（MFVBA）、狭窄处距体表的检测深度（D），并计算基底动脉与双侧椎动脉颅内段、大脑后动脉PSV（取较高侧测值）比值（PSVBA/PSVVA和PSVBA/PSVPCA），以DSA检查结果为标准计算PSVBA、EDVBA、MFVBA、PSVBA/PSVVA及PSVBA/PSVPCA的受试者操作特性（ROC）曲线下面积，比较上述各参数在不同取值下的敏感度、特异度及准确性。结果（1）基底动脉近段狭窄发生于（90±5.4）mm处，中段狭窄发生于（97±3.0）mm处，而远段狭窄常发生于（104±4.2）mm处。（2）基底动脉狭窄诊断最佳血流动力学参数：轻度狭窄的最佳参数标准为110 cm/s≤PSV≤150 cm/s或65 cm/s≤MFV≤90 cm/s。中度狭窄为150 cm/s≤PSV≤210 cm/s或90 cm/s≤MFV≤135 cm/s。重度狭窄为PSVBA≥210 cm/s或PSVBA/PSVVA≥3.5。结论 TCD或TCCS联合评估基底动脉狭窄，选择PSV、MFV及PSVBA/PSVVA血流动力学参数可以准确评估基底动脉狭窄性病变。%ObjectiveTo investigate the accuracy of hemodynamic parameters of diagnostic criteria for basilar artery stenosis by transcranial Doppler (TCD) combined with transcranial color code sonography (TCCS).Methods261 cases with basilar artery stenosis detected by TCD or TCCS and confirmed by DSA were included in this study. The velocity of peak systolic (PSVBA), end diastolic (EDVBA), mean velocity (MFVBA), the depth (D) at the stenosis, the highest PSV of bilateral posterior cerebral arteries (PSVPCA) and intracranial segment of vertebral artery (PSVVA) were detected and recorded respectively. Depending on the findings of DSA, the receiver operating characteristic curve (ROC) was used to evaluated the sensitivity, specificity and accuracy for the PSVBA, EDVBA, MFVBA, PSVBA/PSVVA and PSVBA/PSVPCA. ResultsThe depth of proximal, middle and distal segment of basilar artery stenosis were detected at (90±5.4) mm, (97+3.0) mm, and (104+4.2) mm respectively. The best parameter of diagnostic criteria for the mild、middle and severe basilar artery stenosis were 110 cm/s≤PSVBA≤150 cm/s or 65 cm/s≤MFVBA≤90 cm/s, 150 cm/s≤PSVBA≤210 cm/s or 90 cm/s≤MFVBA≤135 cm/s and PSVBA≥210 cm/s or PSVBA/PSVVA≥3.5.ConclusionThe combination of TCD and TCCS, and choosing the hemodynamic parameters of PSV, MFV and PSVBA/PSVVA , can better assess the basilar artery stenosis, especially for severe basilar artery stenosis.
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