经颅多普勒与经颅彩色多普勒评估大脑中动脉搏动性与阻力差异显著：后处理方式的影响
本研究在123名健康志愿者中比较传统经颅多普勒（TCD）与经颅彩色多普勒（TCCD）测量大脑中动脉PSv、EDv、PI和RI的差异。结果显示TCCD角度校正后各参数均与TCD显著不同（p<0.0001），TCCD的PI高33%、RI高18%，主要源于EDv差异，可能与信号后处理不同有关。
要点
- TCCD测得的PI和RI分别比传统TCD高33%和18%，主要来自EDv差异。
- TCCD的PSv、PI和RI方差显著大于TCD，提示其区分度可能更高。
- 两种技术EDv平均差异+7.28 cm/s，手动后处理TCD EDv信号差异+7.36 cm/s。
诊断标准与关键数值
- TCCD角度校正后PSv、EDv、PI和RI均与TCD不同（均p<0.0001）。
- TCCD的PSv、PI和RI方差大于TCD（分别为p=0.01、p=0.0003、p=0.005）。
- Bland-Altman分析显示多数参数存在非线性偏倚，EDv平均平均差异+7.28 cm/s。
- 手动后处理TCD EDv信号显示差异+7.36 cm/s。
- TCCD较传统TCD的PI高33%、RI高18%。
临床应用与阅片要点
- 日常阅片和报告时应注意TCD与TCCD测得的PI、RI不可直接互换，TCCD值系统性偏高。
- 解读脑血流动力学参数时需考虑设备及后处理方式对EDv的影响。
局限性
- 本研究为试点研究，仅纳入健康志愿者，样本量123例。
- 原文未报告多中心数据或不同设备间的验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: At present, many clinical examinations of the cerebral circulation include a non-imaging transcranial Doppler (TCD) assessment. While post-hoc correction of Doppler angles has been attempted by imaging probes through a temporal window, measurement error may not be fully compensated and may translate into inaccurate quantification of clinically-meaningful parameters, such as pulsatility index (PI). Therefore, the purpose of this study was to compare the traditional TCD with transcranial color-coded Doppler (TCCD).
METHODS: For this pilot study in 123 healthy volunteers, middle cerebral artery (MCA) measurements of peak-systolic velocity (PSv), end-diastolic velocity (EDv), PI and resistance index (RI) of the MCA were compared between conventional non-imaging TCD and TCCD. Data were analyzed with paired, two-tailed t-tests, Bland-Altman limits of agreement and polynomial second-order regression analysis. Post-hoc custom signal post-processing was used exploratively to attempt to interpret observed differences.
RESULTS: After angle-correction with TCCD, PSv, EDv, PI and RI were different from TCD (all p < 0.0001), and the variances of PSv, PI and RI were greater with TCCD (p = 0.01, p = 0.0003, p = 0.005, respectively). Bland-Altman analyses revealed non-linear bias for most parameters, with an average mean difference of +7.28 cm/s in EDv. Manual post-processing of the TCD EDv signal revealed a discrepancy of +7.36 cm/s.
CONCLUSION: Compared with conventional TCD, TCCD generated a 33% higher PI and 18% higher RI, largely due to differences in EDv and likely explained by differences in signal post-processing. The greater variances observed with TCCD distinguish it from traditional TCD and may present an opportunity to provide a more sensitive marker of cerebral hemodynamics and clinical categorization of patients. Collectively, the findings suggest a much-needed reconsideration of ultrasound-based cerebrovascular assessments.
引用
- Stöhr EJ, Al-Shezawi M, Watkeys L, et al. Large Differences in Pulsatility and Resistance of the Middle Cerebral Artery Assessed With Transcranial Doppler Versus Transcranial Color-Coded Doppler: Impact of Post-Processing Approaches. Ultrasound Med Biol. 2026. PMID: 42120262. doi:10.1016/j.ultrasmedbio.2026.03.029
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。