超声在严重颈动脉狭窄中的诊断性能：区分近闭塞亚型与常规重度狭窄
该回顾性研究纳入78例超声提示NASCET狭窄>80%的患者，评估双功能超声区分常规重度狭窄、无完全塌陷的近闭塞及伴完全塌陷的近闭塞的能力。结果显示超声与血管造影分类一致率仅54%，速度指标无法可靠区分无完全塌陷的近闭塞与常规重度狭窄，直径指标有一定价值但总体诊断增益有限，额外影像常仍必要。
要点
- 超声与血管造影分类一致率仅54%，无完全塌陷的近闭塞易被误判为常规重度狭窄（85%）。
- 速度指标无法可靠区分无完全塌陷的近闭塞与常规重度狭窄，是临床难点。
- 远端ICA直径<3.15 mm及ICA/ECA比值<0.98有助于区分常规重度狭窄与近闭塞。
关键影像表现/征象
- 超声与血管造影分类总体一致率为54%。
- 无完全塌陷的近闭塞被误分类为常规重度狭窄的比例达85%。
- 伴完全塌陷的近闭塞可通过狭窄处及远端收缩期和舒张末期流速及其衍生比值区分，AUC为0.70-0.76。
- 直径指标可区分常规重度狭窄与两种近闭塞类型：远端ICA<3.15 mm（AUC 0.79）和ICA/ECA比值<0.98（AUC 0.78）。
- 多变量模型提高区分性能，AUC达0.82。
诊断标准与关键数值
- 远端ICA直径<3.15 mm用于区分常规重度狭窄与近闭塞，AUC 0.79。
- ICA/ECA比值<0.98用于区分常规重度狭窄与近闭塞，AUC 0.78。
- 伴完全塌陷的近闭塞可通过流速指标区分，AUC 0.70-0.76。
临床应用与阅片要点
- 超声发现重度狭窄时，应警惕无完全塌陷的近闭塞可能，避免仅凭速度指标排除。
- 可结合远端ICA直径和ICA/ECA比值辅助区分常规重度狭窄与近闭塞。
- 超声可用于随访，血流动力学变化可能提示远端塌陷进展。
- 对于超声难以鉴别的病例，常需CTA、MRA或DSA进一步确认。
局限性
- 回顾性研究设计。
- 样本量较小（78例）。
- 单中心研究。
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
PURPOSE: Carotid near-occlusion (CNO) is a subtype of severe carotid stenosis characterized by partial or complete distal internal carotid artery (ICA) collapse. Its diagnosis currently relies on angiographic imaging, and no validated duplex ultrasound (DUS) criteria exist. We aimed to assess the utility of DUS in distinguishing conventional high-grade stenosis (HGS), CNO without, and CNO with full collapse.
METHODS: We retrospectively included patients with > 80% NASCET stenosis on DUS (2012-2021) who underwent CTA, MRA, or DSA within 3 months. DUS parameters were compared across groups defined by angiographic classification using uni- and multivariable analyses.
RESULTS: Among 78 patients, 21 had HGS, 34 CNO without, and 23 CNO with full collapse. DUS agreed with angiographic classification in 54%, with CNO without full collapse often misclassified as HGS (85%). Velocity-based DUS metrics could not reliably distinguish CNO without full collapse from HGS. However, CNO with full collapse was distinguishable based on stenotic and distal peak-systolic and end-diastolic velocities and derived ratios (AUCs 0.70-0.76). Diameter-based metrics distinguished HGS from both CNO types: distal ICA < 3.15 mm (AUC 0.79) and ICA/ECA ratio < 0.98 (AUC 0.78). Multivariable models increased discriminatory performance (AUC 0.82).
CONCLUSION: Velocity-based DUS metrics cannot reliably distinguish HGS from CNO without full collapse, representing a key clinical challenge. Although DUS-derived metrics were associated with angiographically defined CNO with full collapse, overall diagnostic gain was modest and additional imaging will often remain necessary. Nevertheless, DUS remains useful for follow-up, as hemodynamic changes may indicate evolving distal collapse.
引用
- Inauen C, Barnaure I, Herzog L, et al. Duplex ultrasound in severe carotid stenosis: diagnostic performance for differentiating near-occlusion subtypes from conventional high-grade stenosis. Neuroradiology. 2026. PMID: 42159713. doi:10.1007/s00234-026-04005-9
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。