对比增强经颅彩色编码实时超声联合颈总动脉压迫试验在颞骨窗不足患者前交通动脉通畅性术前评估中的作用
The role of contrast-enhanced transcranial color-coded real-time sonography combined with the common carotid artery compression test in preoperative evaluation of anterior communicating artery patency in patients with insufficient temporal bone windows.
文献信息
| PMID | 42745971 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ying Liu |
| 作者单位 | Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. |
| 期刊 | Frontiers in neurology |
| SCI 分区 | Q2 |
| IF | 3.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 本研究旨在使用对比增强经颅彩色编码实时超声（CE-TCCS）联合颈总动脉压迫（CCC）试验，评估计划接受颈动脉内膜剥脱术（CEA）且颞骨窗欠佳患者的前交通动脉（ACoA）通畅性。
方法： 对116例颞骨窗欠佳且存在症状性颈动脉狭窄（sCAS）的患者进行前瞻性分析。基于TCCS和CE-TCCS数据，分析颅内Willis环（CoW）的显示率，包括大脑前动脉（ACA）、大脑中动脉和大脑后动脉。通过CE-TCCS在有和无CCC试验条件下评估ACoA的功能性通畅性，并将结果与CTA确定的解剖学通畅性进行比较。
结果： CE-TCCS中CoW的可视化率显著提高（p < 0.001）。CE-TCCS因单侧ACA-A1段缺如排除了24例患者。我们评估了92例患者的ACoA通畅性。以CTA作为解剖学参考标准，CE-TCCS联合CCC试验的敏感性为94.67%，特异性和阳性预测值为100%，阴性预测值为80.95%，总体诊断准确率为95.65%。与CTA相比，CE-TCCS联合CCC试验无显著差异（p = 0.125），且一致性极好（Kappa = 0.868，95% CI：0.743-0.993，p < 0.001），而单独CE-TCCS与CTA差异显著（p < 0.001），一致性差（Kappa = 0.126，95% CI：0.053-0.199，p = 0.013）。CE-TCCS联合CCC试验检测到的功能性ACoA通畅率为77.2%，而单独CE-TCCS漏诊了70.4%的通畅病例。
结论： CE-TCCS显著提高了颅内CoW的显示率。CE-TCCS联合CCC试验可作为颞骨窗不足患者ACoA通畅性术前评估的可靠技术。
英文摘要
OBJECTIVE: The purpose of the study was to evaluate the anterior communicating artery (ACoA) patency in patients with suboptimal temporal bone windows who were scheduled for carotid endarterectomy (CEA), using contrast-enhanced transcranial color-coded real-time sonography (CE-TCCS) combined with common carotid artery compression (CCC) test.
METHOD: A prospective analysis was conducted on 116 patients with suboptimal temporal bone windows who exhibited symptomatic carotid artery stenosis (sCAS). The display rates of intracranial circle of Willis (CoW) including anterior cerebral artery (ACA), middle cerebral artery, and posterior cerebral artery, were analyzed based on TCCS and CE-TCCS data. The functional patency of the ACoA was assessed by CE-TCCS with and without the CCC test, and the results were compared with the anatomical patency determined by CTA.
RESULT: The visualization rates of CoW were significantly improved in CE-TCCS (p < 0.001). CE-TCCS excluded 24 patients due to unilateral absence of the ACA-A1 segment. We assessed the patency of the ACoA in 92 patients. With CTA as the anatomical reference standard, CE-TCCS combined with CCC test yielded 94.67% sensitivity, 100% specificity and positive predictive value, 80.95% negative predictive value, and 95.65% overall diagnostic accuracy. Compared with CTA, CE-TCCS combined with CCC test showed no significant difference (p = 0.125) and excellent consistency (Kappa = 0.868, 95% CI: 0.743-0.993, p < 0.001), whereas standalone CE-TCCS differed significantly from CTA (p < 0.001) with poor consistency (Kappa = 0.126, 95% CI: 0.053-0.199, p = 0.013). The functional ACoA patency rate detected by CE-TCCS combined with CCC test was 77.2%, while 70.4% of patent cases were missed by CE-TCCS alone.
CONCLUSION: CE-TCCS significantly improve the display rate of intracranial CoW. CE-TCCS combined with the CCC test can serve as a reliable technique in preoperative evaluation of ACoA patency in patients with inadequate temporal bone windows.