The Comparative Study of TCD and DSA in the Diagnosis of Cerebralischemic Stroke
|School||Guangzhou University of Traditional Chinese Medicine|
|Course||Traditional Chinese Medicine|
|Keywords||Ischemic cerebrovascular disease Transcranial Doppler Digital subtraction angiography Collateral circulation Responsibility vascular Ischemic stroke Dialectical type By brain Doppler|
Cerebrovascular disease is the high incidence and high mortality rate, a class of diseases, with an aging population and people's diet structure changes, the trend of getting younger and younger, and the increase in the incidence of ischemic cerebrovascular disease, serious impact on the elderly quality of life. How early detection of cerebrovascular disease has become the current concern hotspot; early and accurately determine cerebral artery stenosis, the degree of stenosis, and take timely and effective treatment measures to reduce the incidence or recurrence rate of ischemic cerebrovascular disease has important significance. , Cerebrovascular digital subtraction is the gold standard for the diagnosis of ischemic cerebrovascular disease, but the innovation and the high cost is not accepted by some patients. Transcranial Doppler ultrasound (TCD) for quick traumatic intracranial vascular screening technology, has been widely used in clinical. Research at home and abroad have long found, TCD accuracy in the detection of patients with ischemic cerebrovascular disease, cerebral artery stenosis reported inconsistent, leading to many clinicians TCD diagnosis of cerebral artery stenosis reliability in doubt. This study analyzes encephalopathy center TCD application of clinical diagnosis of ischemic cerebrovascular disease compared with DSA results, to assess its clinical value in the diagnosis of ischemic cerebrovascular disease. In addition, stroke TCM dialectical modern imaging studies seldom explore the TCD in the clinical diagnosis of ischemic stroke dialectical typing value, aims to provide a reference for the Chinese and western medicine of the future of this disease. The first part of Objective To compare the differences in the diagnosis of ischemic cerebrovascular disease by transcranial Doppler ultrasound (TCD) and digital subtraction angiography (DSA). Methods A retrospective analysis of I Medical Center in January 2005 -2009 in October 270 patients with ischemic cerebrovascular disease in patients with DSA and TCD data, the two test results for comparative analysis phases. Results ① from 2005 to 2006, 121 patients with ischemic cerebrovascular disease patients, a total of 1331 detection of vascular, TCD diagnostic sensitivity 40.1%, specificity 83.4%, positive predictive value of 23.7%, negative predictive value of 91.5%; ② from 2007 to 2009, 149 cases of ischemic cerebrovascular disease patients, were detected in the blood vessels of 1639 TCD diagnostic sensitivity 56.3%, specificity 87.7%, positive predictive value of 42.9%, negative predictive value of 92.4%. (3) of 270 patients with ischemic cerebrovascular disease were detected vascular 2970 DSA as a standard TCD sensitivity for the diagnosis of ischemic cerebrovascular disease 49.9%, specificity 85.7%, positive predictive value of 34.1%, The negative predictive value was 92%. Conclusion TCD vascular assessment of patients with ischemic cerebrovascular disease is a primary screening methods, the inspection results is still possible as one of the important basis of the clinical diagnosis purpose by analyzing TCD different parts of the feeding arteries in patients with cerebral ischemic cerebrovascular disease different stenosis check results and factors affecting TCD accuracy; explore responsibility artery stenosis or occlusion occurred characteristics, severe stenosis or occlusion of collateral circulation compensatory way, to assess the the TCD clinical diagnostic value. Retrospective analysis method ① Center in January 2007 -2009 in October 149 patients with ischemic cerebrovascular disease patient data to DSA standards, analysis of the TCD diagnosis of different lesions, vascular stenosis, sensitivity, specificity, positive predictive value and negative predictive value; using ROC curve analysis TCD on the left and right sides of different vascular sensitivity and specificity. ② Logistic regression was used to analyze the factors that affect TCD accuracy. ③ DSA as a standard, the blood vessels of the responsibility of the 149 patients with ischemic cerebrovascular disease, assessment of collateral circulation. Results ① ischemic cerebrovascular disease vascular lesions in the left cerebral hemisphere was significantly higher than the right hemisphere vascular lesions, P lt; 0.05 cerebral artery lesions highest vertebral artery stenosis incidence, followed by the middle cerebral artery, internal carotid artery ; ② TCD value of the middle cerebral artery, the sensitivity, specificity, respectively, 72.1% and 89%. ROC curve comparison analysis of the left and right sides of the branch vessel sensitivity, specificity, and the left middle cerebral artery sensitivity of 84.4%, significantly higher than 58.6% of the right middle cerebral artery, P lt; 0.05. The the ③ TCD diagnosis of severe vascular stenosis sensitivity, specificity was significantly higher than moderate, mild stenosis, P lt; 0.05. ④ age affect TCD low diagnostic sensitivity factors, different technical operator, clinical diagnostic classification, in which the operator is the main influencing factors. (5) of 149 patients, DSA found 134 cases (89.7%) were seen feeding artery stenosis or occlusion, TCD found in 94 patients (63.1%) artery stenosis or occlusion, 130 cases to determine responsibility vessels, vascular lesions are severe stenosis or occlusion. responsibility vascular highest incidence of middle cerebral artery. ⑥ DSA standard, 45 cases (30.2%) patients with intracranial collateral circulation TCD to detect the presence of intracranial collateral circulation in 26 cases (17.4%) the TCD sensitivity of the collateral circulation was 40%, specificity of 92.3%. Internal carotid artery stenosis or occlusion, collateral circulation was significantly higher than that of other lesions, carotid artery collateral circulation compensatory Willis ring compensatory-based, middle cerebral artery, the anterior cerebral artery soft film compensatory based. Conclusion ① ischemic cerebrovascular disease left cerebral hemisphere of the high incidence of vascular lesions in the right hemisphere, where the highest incidence of vertebral artery stenosis. ② TCD diagnostic value of the middle cerebral artery, other arteries diagnosis need to be careful. The operations are the main factors affecting the TCD accuracy. ③ TCD diagnosis of vascular severe stenosis have a higher accuracy. ④ collateral circulation to the internal carotid artery stenosis or occlusion of the common compensatory manner to the main circle of Willis compensatory, followed by the middle cerebral artery, the compensatory mainly soft film compensatory vertebral artery stenosis compensatory mode diversification. The third part of the purpose of analysis by transcranial Doppler ultrasound (TCD) and digital subtraction angiography (DSA) of ischemic stroke patients with different TCM dialectical typing of clinical diagnostic value. Methods DSA analysis of 149 cases of ischemic stroke patients, TCD, DSA as standard, to explore TCD of ischemic stroke dialectical type of sensitivity, specificity, positive predictive value, negative predictive value. Results of 149 cases of ischemic stroke patients wind, fire, phlegm and blood stasis, closed block the majority of context card type (50.3%), followed by liver-yang hyperactivity, Wind \u0026 Fire on disturbance (24.8%). TCD ischemic stroke, liver-yang hyperactivity, Wind \u0026 Fire on maximum disturbance permit sensitivity 67.9%, specificity 88.3%, QDBS a sensitivity of 61.5%, specificity 90.3%, the highest dialectical The diagnostic indicators Statistics typing analysis no significant statistical significance. Conclusion ischemic cerebrovascular disease patients Wind Phlegm blood, Blockage of context by the majority, phlegm and blood are the main aspects of patients with ischemic cerebrovascular disease, Phlegm theoretical in the future to guide the treatment of ischemic stroke, enrich and perfect Chinese and Western treatment of ischemic stroke has important significance to improve the clinical efficacy. No obvious clinical significance of the TCD test results dialectical type of ischemic stroke.