经颅彩色多普勒超声、磁共振血管成像对单侧大脑中动脉狭窄筛查诊断价值的ROC曲线分析

摘要

目的 通过受试者工作特征(receiver operating characteristic,ROC)曲线分析评估经颅彩色多普勒超声(transcranial color-coded sonography,TCCS)和磁共振血管成像(magnetic resonance angiography,MRA)对于单侧大脑中动脉(middle cerebral artery,MCA)狭窄的诊断价值.方法 选取行 TCCS、MRA 及头颈部 CT 血管成像(CT angiography,CTA)3种检查方法的单侧 MCA 狭窄患者127例,以 CTA 检查结果为标准,其中137根正常MCA,117根狭窄者,按程度分为正常、轻度狭窄、中度狭窄及重度狭窄,然后进行 ROC 曲线分析.结果 TCCS与MRA在诊断单侧 MCA狭窄的曲线下面积分别为0.989(95%CI 0.967~0.998)、0.991(95%CI 0.970~0.999),差异无统计学意义(P>0.05);在诊断单侧MCA轻度-中度狭窄的曲线下面积分别为0.959(95%CI 0.796~0.941)、0.882(95%CI 0.894~0.989),MRI诊断价值高于TCCS,差异有统计学意义(P<0.05);在诊断单侧 MCA 中度-重度狭窄的曲线下面积分别为0.939(95% CI 0.847~0.984)、0.955(95% CI 0.868~0.991),差异无统计学意义(P>0.05).结论 TCCS和 MRA 2种检查作为筛查单侧 MCA 狭窄方法均具有较高的诊断价值,尤其在诊断轻度-中度狭窄分级上,MRA诊断价值高于TCCS.%Objective To evaluate transcranial color-coded sonography(TCCS)and magnetic resonance angiography(MRA)in screening of diagnosing unilateral middle cerebral artery(MCA)stenosis by using receiver operating characteristic(ROC)curve analysis.Methods A total of 127 patients with unilateral middle cerebral artery(MCA)stenosis were enrolled in this study.TCCS,MRA and CT angiography(CTA)of head and neck were performed in all patients. Based on CTA results,1 3 7 normal MCA of root in the control group,1 1 7 MCA with stenosis were divided into 4 categories:normal,mild stenosis,moderate stenosis and severe stenosis, then the data were evaluated using ROC curve analysis.Results The two diagnostic methods of TCCS and MRA were of high value in the diagnosis of stenosis in the unilateral MCA.The area under the curve of TCCS and MRA were 0.989(95%CI 0.967-0.998)and 0.991(95%CI 0.970-0.999),and the area under the curve was not statistically significant(P>0.05).The diagnostic value of MRI was higher than that of TCCS in the diagnosis of mild to moderate stenosis in the unilateral MCA.The area under the curve was 0.959(95%CI 0.796-0.941)and 0.882(95%CI 0.894-0.989)respectively,and the area under the curve was statistically different(P<0.05).In the diagnosis of moderate to severe stenosis,both methods have high value,and the area under the curve is 0.939(95%CI 0.847-0.984)and 0.955(95%CI 0.868-0.991)respectively,and the area under the curve is not statistically significant(P>0.05).Conclusion Both TCCS and MRA tests have high diagnostic value as a method for screening the arterial stenosis in the unilateral MCA,especially in the diagnosis of mild to moderate stenosis,the diagnostic value of MRA is higher than that of TCCS.