GIÁ TRỊ CỦA SIÊU ÂM DUPLEX TRONG CHẨN ĐOÁN HẸP ĐỘNG MẠCH CẢNH TRONG ĐOẠN NGOÀI SỌ Ở BỆNH NHÂN NHỒI MÁU NÃO

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Ngọc Cường Đỗ, Dũng Tiến Đoàn, Hoàng Ẩn Nguyễn, Hoàng Thuấn Nguyễn, Thị Xuân Mai Nguyễn, Trần Như Ngọc Nguyễn, Vũ Đằng Nguyễn, Quách Trân Trân Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.60-70

Bộ sưu tập: Metadata

ID: 426884

Thêm vào giỏ Liên kết toàn văn

Background: Extracranial carotid artery stenosis is one of the main causes of cerebral infarction, estimated to cause approximately 8-15% of cerebral infarctions. The correct diagnosis of this pathology contributes to the clinician's ability to predict the patient's prognosis and select the appropriate treatment. Duplex ultrasound can be used as a non-invasive and inexpensive diagnostic tool to detect carotid artery stenosis in the extracranial segment. Objectives: The objective of our study is to describe the clinical features, characteristics of duplex ultrasound and evaluate the value of duplex ultrasound for the diagnosis of extracranial internal carotid stenosis in patients with cerebral infarction. Materials and methods: A prospective cross-sectional study involving 64 brain infarction patients (128 internal carotid arteries on both sides) at Can Tho Central Hospital from 03/2021 to 06/2023. Results: The clinical symptoms of cerebral infarction include weakness/ hemiplegia (95.3%) and central facial paralysis (62.5%). Cerebral infarction patients had 62.5% of extracranial internal carotid artery stenosis/occlusion. Duplex ultrasound has high value in the diagnosis of extracranial intracranial carotid artery stenosis with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 96.6%, 99.0%, 98.4%, 96.6% and 99.0%, respectively, very high consensus (= 0.955, 95% CI = 0.894 - 1, p <
0.001) when the narrowness ≥ 50%, with a narrowing ≥ 70%, the values are 92.3%, 99.1%, 98.4%, 92.3%, and 99.1%, respectively, the consensus is also very high ( = 0.914, 95% CI = 0.796 - 1, p <
0.001) compared to DSA. Duplex ultrasound and DSA have a high correlation in the diagnosis of extracranial internal carotid atery stenosis (Spearman’s rs = 0.728, 95% CI: 0.632 - 0.803, p <
0.001). Conclusion: Duplex ultrasound is a non-invasive, inexpensive, safe and highly accurate imaging tool for diagnosing intracranial carotid artery stenosis, which can be used as an initial screening tool for stenosis classification and/or as a definitive diagnostic method.Đặt vấn đề: Hẹp động mạch cảnh trong đoạn ngoài sọ là một trong những nguyên nhân chính của đột quỵ nhồi máu não, ước tính gây ra khoảng 8 - 15% các ca nhồi máu não. Việc chẩn đoán chính xác bệnh lý này góp phần giúp bác sĩ lâm sàng có tiên lượng và lựa chọn phương pháp điều trị thích hợp. Siêu âm duplex là phương tiện chẩn đoán không xâm lấn, rẻ tiền giúp chẩn đoán hẹp động mạch cảnh trong đoạn ngoài sọ. Mục tiêu: Mô tả đặc điểm lâm sàng, đặc điểm siêu âm duplex và đánh giá giá trị của siêu âm duplex trong chẩn đoán hẹp động mạch cảnh trong đoạn ngoài sọ ở bệnh nhân nhồi máu não. Đối tượng và phương pháp nghiên cứu : Nghiên cứu tiến cứu, phân tích mô tả cắt ngang trên 64 bệnh nhân được chẩn đoán nhồi máu não và nhập viện điều trị tại Bệnh viện Đa khoa Trung ương Cần Thơ từ tháng 03/2021 đến tháng 06/2023. Kết quả : Triệu chứng lâm sàng phổ biến của nhồi máu não là yếu/liệt nửa người (95,3%) và liệt mặt trung ương (62,5%). Bệnh nhân nhồi máu não có hẹp/tắc động mạch cảnh trong ngoài sọ chiếm tỉ lệ 62,5%. Siêu âm duplex có giá trị cao trong chẩn đoán hẹp động mạch cảnh trong ngoài sọ với độ nhạy, độ đặc hiệu, độ chính xác, giá trị tiên đoán dương và giá trị tiên đoán âm lần lượt là 96,6%, 99,0%, 98,4%, 96,6% và 99,0%, độ đồng thuận rất cao (κ = 0,955, 95% CI: 0,894 - 1, p <
0,001) khi độ hẹp ≥ 50%, với mức hẹp ≥ 70%, giá trị lần lượt là 92,3%, 99,1%, 98,4%, 92,3% và 99,1%, độ đồng thuận cũng rất cao (κ = 0,914, 95% CI: 0,796 - 1, p <
0,001) so với DSA. Siêu âm duplex và DSA có mối tương quan chặt chẽ trong chẩn đoán hẹp động mạch cảnh trong ngoài sọ (Spearman’s rs = 0,728, 95% CI: 0,632 - 0,803, p <
0,001). Kết luận : Siêu âm duplex là phương tiện chẩn đoán hình ảnh không xâm lấn, rẻ tiền, có độ an toàn và chính xác cao trong chẩn đoán hẹp động mạch cảnh trong đoạn ngoài sọ, có thể sử dụng như một công cụ sàng lọc ban đầu phân loại hẹp và/hoặc như một phương pháp chẩn đoán xác định.

1. Đọc trực tuyến

1. Đọc trực tuyến

Tạo bộ sưu tập với mã QR