Pre-surgical evaluation of ICA-stenosis using 3D power Doppler, 3D color coded Doppler sonography, 3D B-flow and contrast enhanced B-flow in correlation to CTA/MRA: First clinical results
Pre-surgical evaluation of ICA-stenosis using 3D power Doppler, 3D color coded Doppler sonography, 3D B-flow and contrast enhanced B-flow in correlation to CTA/MRA: First clinical results
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DOI：
10.3233/ch-2009-1161
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发表时间：
2009-01-01
影响因子：
2.1
通讯作者：
Jung, E. M.
中科院分区：
文献类型：
--
作者：
Pfister, K.;Rennert, J.;Jung, E. M.
目的：应用数字化三维超声技术，根据NASCT标准对颈内动脉狭窄程度进行术前评估。材料/方法：在一项前瞻性研究中，25例神经功能障碍患者，年龄54~88岁，平均75岁，均行彩色编码双功超声(CCDS)、3D CCDS、3D能量多普勒、3D B-Flow、对比增强3D B-Flow及CTA/MRA检查。超声检查由经验丰富的检查员使用多频线性换能器(6~9 MHz，Logiq 9，GE)进行。静脉注射Sonovue 2.4ml后，采用低机械指数技术(MI<；0.16)进行3D-Flow增强扫描。作为评价颈内动脉狭窄程度的参考方法，每个患者均行CTA(多层螺旋CT，Sensation 16，西门子)和/或MRA(1.5T，西门子)。手术指征(颈动脉EEA)遵循NASCET标准。所有图像由两名观察者独立解释和评估，并测量ICA狭窄程度。对于狭窄程度的评估，使用了从50%到99%的10%的范围。统计学处理采用Spearman相关分析和Wilcoxon Sign Rank检验，显着性阈值为0.05。结果：术中和CTA/MRA对颈内动脉狭窄程度的评估范围为60%~99%(平均80%)。配对Wilcoxon检验仅对有无造影剂的3D B-flow无显著差异(p<；0.05)。Spearman相关检验对ICA狭窄程度与手术评估的相关性分别为：B超0.77，3D CCDS 0.90，3D能量多普勒0.84，B-Flow 0.91，对比增强3D B-Flow 0.93。当存在圆形钙化时，3D B-Flow的增强血流检测被证明是有用的。只有3D B-Flow才有可能显示严重和深度狭窄(70-99%)的狭窄内变异，而不会出现开花和混响伪影。结论：与手术和CTA/MRA对照，使用3DB-FLOW对颈内动脉狭窄的程度和形态进行有效的评价是可行的。
Aim: Pre-surgical evaluation of the extent of internal carotid artery stenosis (ICA) according to NASCT criteria using digital 3D ultrasound methods.Material/Methods: In a prospective study, 25 patients (54-88 years, mean 75) with neurological deficits and the diagnosis of ICA stenosis underwent pre-surgical ultrasound examination using Color Coded Duplex Sonography (CCDS), 3D CCDS, 3D power Doppler, 3D B-flow, contrast enhanced 3D B-flow, and CTA/MRA. Ultrasound was performed by an experienced examiner with a multifrequency linear transducer (6-9 MHz, Logiq 9, GE). After bolus injection of 2.4 ml Sonovue i. v., low mechanical index technique (MI < 0.16) was used for contrast enhanced 3D B-flow. As reference method for evaluation of the extent of ICA stenosis each patient underwent CTA (multislice CT, Sensation 16, Siemens) and/or MRA (1.5 T, Symphony Siemens). Indications for surgery (carotid EEA) followed the NASCET criteria. All images were interpreted and evaluated independently by two observers with three measurements of the degree of the ICA stenosis. For assessment of the extent of stenosis a 10%-scale from 50% to 99% was used. Statistical analysis was performed using Spearman Correlation and Wilcoxon Signed Rank Test with a significance threshold of p < 0.05.Results: Assessment of the extent of ICA stenosis during surgery and in CTA/MRA displayed a range from 60% to 99% (mean 80%). Non significant differences were found with paired Wilcoxon test only for 3D B-flow with and without contrast medium (p < 0.05).Correlation with surgical evaluation regarding the extent of ICA stenosis using Spearman correlation teat was 0.77 for B-scan, 0.90 for 3D CCDS, 0.84 for 3D Power Doppler, 0.91 for B-flow and 0.93 for contrast enhanced 3D B-flow. When circular calcifications were present, contrast enhanced flow detection of 3D B-flow proved to be useful. Visualisation of intrastenotic variances of severe and profound stenosis (70-99%) without blooming and reverberation artefacts was possible only with 3D B-flow. This facilitates the detection of the morphology of plaques ulcers as an embolic source.Conclusion: In correlation with surgery and CTA/MRA, a valid evaluation of the extent and morphology of ICA stenosis using 3D B-flow, with and without contrast medium, is feasible.