The Application Of Transcranial Doppler In Diagnosis Of Intracranial Atrery Stenosis

Ischemic cerebrovascular disease（ICVD） is a common disease of the nervous syste-m.ICVD get attention because of its high incidence、high morbidity、higher mortality, higherdeadly and higher recurrence.Intracranial arterial stenosis or occlusion caused byatherosclerosis plays an important role in the causes of ischemic cerebrovascular disease.Weshould find a useful technique which is convenience、invasive、inexpensive and accuracy.Now, the commonly used methods in clinical detection of intracranial arteries comprises aretranscranial Doppler(TCD), magnetic resonance angiography (MRA), CT angiography(CTA), digital subtraction angiography (DSA) and so on.DSA is the golden standard of diagnosis in intracranial artery stenosis or occlusion, butbecause of its invasive, expensive characteristics and other shortcomings, it is still not theroutine examination of screening for intracranial arterial stenosis.TCD is a new and effectivetype to diagnose intracranial artery stenosis disease.TCD not only can determine whetherthere is cerebrovascular disease,but also can detect whether there is compensatory collateralafter arteriostenosis.Regulate the result of CTA as the standard, determine the clinical valueof TCD in the diagnosis of cerebral artery stenosis.265cases with ischemic cerebrovascular disease in our hospital from December2010toDecember2011are chosen in our study.We use Logistic regression analysis to analyse thecorrelation between the stroke risk factors (hypertension, high blood lipids, high blood sugar,etc.)There were60cases underwent TCD and CTA examination within one week, whohighly suspected intracranial artery stenosis.Regulate the result of CTA as thestandard,compute the specificity and sensibility and positive predictive value and negativepredictive value and Kappa of TCD in the diagnosis of cerebral artery stenosis，anddetermine the clinical value of TCD.T test is applied in the test of both sides of the bloodflow velocity after the MCA is stenosis.And use ROC curves to judge the best flow velocityof MCA lesions who highly suspected intracranial artery stenosis.Studies have shown that: dyslipidemia is the most risk factor with the occurrence ofICVD.Regulate the result of CTA as the standard, Analysis shows that the sensibility andspecificity and positive predictive value and negative predictive value and Kappa of TCD in diagnosing MCA and ACA and PCA and VA and BA are97.4%、92.6%、86.4%、98.7%；88.2%、95.1%、75%、98%；37.5%、99.1%、75%、95.5%；76.9%、97.2%、76.9%、97.2%；100%、96.4%、71.4%、100%;0.87、0.78、0.48、0.82、0.74。In ICVD patientswith middle cerebral artery stenosis, cerebral artery blood flow velocity of the anteriorcerebral artery,posterior cerebral artery blood flow velocity on the lesion side aresignificantly higher than the contralateral lesions (P <0.01), also，cerebral artery blood flowvelocity of the vertebral cerebral artery on the lesion side are significantly higher than thecontralateral lesions (P＞0.05).Anterior cerebral artery and posterior cerebral artery are maincollateral circulation when middle cerebral artery is stenosis.The collateral circulation ofvertebral cerebral is poor.Using ROC curves to judge the best flow velocity of MCA lesionswho highly suspected intracranial artery stenosis,the systolic velocity is163.5cm/s, the meanvelocity is117.0cm/s,the diastolic velocity is88.5cm/s.To sum up, the following conclusions can be drawn: It’s reliable to diagnose intracranialartery stenosis with TCD,and the CTA examination provide an effective method for cerebralvascular stenosis disease.This examination of TCD proved that TCD can be used as adiagnostic method in screening in intracranial artery stenosis which is convenient, simple,inexpensive.It’s widely used in clinical.Anterior cerebral artery and posterior cerebral arteryare main collateral circulation when middle cerebral artery is stenosis. Dyslipidemia is themost risk factor with the occurrence of Ischemic cerebrovascular disease.