Study On Application Of CE-TCCS In The Diagnosis Of ICVD

Objective:1.Compare conventional ultrasound with CE-TCCS in display rate of the circle ofWillis and intracranial main artery system.2. Compare the difference of the before and after intracranial hemodynamicparameters and discuss the reliability of the CE-TCCS diagnosis of ICVD.3.Comparing the diagnosis of ICVD patients with intracranial arterial stenosis orocclusion to study the clinical value of two ultrasound technology (conventionalultrasound and CE-TCCS).Methods:1.Test object: Choose81cases of ICVD patients hospitalized in August2011toDecember2011at the Department of Neurology as study object.There were35malesand46females, aged43～88years old, average aged(68±9.78)years old.2.Methods:Choosing the ACUSON S20004P1low-frequency fan-shapedscanning probe and exploring the internal carotid artery system by bilateral temporalwindow to observe the display of intracranial circle of Willis and anterior、middlecerebral artery, and to record blood flow spectrum parameters of anterior、middlecerebral artery before and after the contrast;Exploring the basilar artery system bypillow window to observe the display of the vertebral and basilar artery and to recordblood flow spectrum parameters of these arteries before and after the contrast, then doa statistically comparative analysis to the display and blood flow spectrum parametersof the main arteries before and after the contrast. Spectrum parameters indicatorsincluding: Peak systolic velocity(Vp, cm／s), Diastolic velocity(Vd, cm／s),Time(T,s), Systolic／Diastolic(S／D), Resistance index(RI), Pulsatility index(PI).According toclinical need,we take CTA examination for34patients in3days before and afterultrasound contrast, record the results and choose CTA as the gold standard to analysethe reliability of conventional ultrasound and CE-TCCS diagnosis of ICVD patients with intracranial arterial stenosis or occlusion.Results:1.CE-TCCS took the significantly higher display rates of the circle of Willis, thebilateral middle cerebral artery and double vertebral, basilar artery than theconventional ultrasound(P＜0.05)2.The contrasted blood flow parameters of Vp, Vd, Vm and T of dual vertebralangiography, the basilar artery were significantly higher than before(P＜0.05).Therewere no obvious statistical difference in S／D,RI,PI between conventional ultrasoundand CE-TCCS(P＞0.05). Bilateral anterior and cerebral artery can not do the statisticalcomparison due to the small number of display before ultrasonic contrast.3.CTA showed51stenosis and8occlusion in238vessels of34patients.Conventional transcranial ultrasound showed9stenosis or occlusion, confirmed byCTA for8；conventional ultrasound prompted117as normal, confirmed by CTA for98. By statistical comparison, the conventional ultrasonic take the sensitivity of13.56%,the specificity of54.75%and the positive predictive value of88.89%for diagnosis of ICVD patients with intracranial arterial stenosis or occlusion, which has low consistent coefficient with CTA (Kappa=0.378, P＜0.05) anddifference with CTA in diagnosing level(P＜0.05);And CE-TCCS prompted47as stenosis or occlusion,42confirmed by CTA, CE-TCCS prompted185as normal,171confirmed by CTA. By statistical comparison, the CE-TCCS take thesensitivity of71.19%,the specificity of95.53%and the positive predictive valueof88.89%for diagnosis of those ICVD patients, which has high consistent coefficient with CTA(Kappa=0.763,P<0.05) and no difference with CTA in diagnosing level(P＜0.05).There is significantly higher diagnostic consistency and specificity between CE-TCCS and CTA than conventional ultrasound in diagnosis ofICVD patients with intracranial arterial stenosis or occlusion.conclusion:Conventional ultrasound shows poor for the intracranial large vessels of ICVDpatients, and hemodynamic parameters of it cann’t evaluate stenosis or occlusion goodenough, so it’s clinical value is not high；CE-TCCS can significantly improve thedisplay of the intracranial artery；And CE-TCCS can more accurately promote vasculardisease of ICVD patients and be more consistent with the CTA diagnosis.