Online publication October 3, 2011 原 著 第 51 回総会座長推薦論文 内頸動脈起始部狭窄病変における収縮期加速時間の有用性 要 旨 : acceleration time; AcT AcT AcT 110 msec NASCET 60
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1 Online publication October 3, 2011 原 著 第 51 回総会座長推薦論文 内頸動脈起始部狭窄病変における収縮期加速時間の有用性 要 旨 : acceleration time; AcT AcT AcT 110 msec NASCET 60 AcT J Jpn Coll Angiol, 2011, 51: Key words: acceleration time, internal carotid artery, ultrasonography 序 言 対象と方法 carotid endarterectomy; CEA carotid artery stenting; CAS 1 acceleration time; AcT 2 3, 4 AcT internal carotid artery; ICA AcT AcT aortic stenosis; AS Vivid7 Dimension GE Healthcare Japan 9 MHz peak systolic velocity; PSV NASCET North American Symptomatic Carotid Endarterectomy Trial 5 AcT 2 3 cm 2 3 cm Fig. 1 AcT 3 2/ AcT THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 51 No
2 Figure 1 Measurement methods of acceleration time (AcT). A: The linear array probe was set in the internal carotid artery (ICA) at 2 3 cm above the ICA origin. The AcT was measured using the average of 3 heartbeats. B: The normal Doppler wave-form pattern. C: Duplex sonogram of a patient with ICA stenosis shows that upstroke is delayed and peak is rounded cut off NASCET AcT Fig. 2 Angio- NASCET Advantx UNV GE Healthcare Japan Allura Xper FD 20/10 PHILIPS 2 2 Mann-Whitney U P<0.05 AcT ROC receiver operating characteristic curve 結果 1 AcT AcT 79.0±15.5 msec msec cut off 94 AcT r=0.64 P<0.01 cut off NASCET 60 Fig. 3 PSV AcT r=0.62 P<0.01 Cut off PSV 170 cm/sec Fig. 4 PSV AcT 366 脈管学 Vol. 51 No. 3
3 2 Figure 2 Comparison of acceleration time in control group (<NASCET 10%) and the stenosis group ( NASCET 10%). NASCET: North American Symptomatic Carotid Endarterectomy Trial Figure 3 Relationship between degree of stenosis by the duplex NASCET method and AcT (r=0.64, P<0.01). AcT has extended by the near occlusion of ICA (arrow head) and the severe kink of ICA (arrow). NASCET: North American Symptomatic Carotid Endarterectomy Trial, AcT: acceleration time, ICA: internal carotid artery September 25,
4 Figure 4 Relationship between PSV of ICA origin and AcT (r=0.62, P<0.01). AcT has extended by the near occlusion of ICA (arrow head) and the severe kink of ICA (arrow). PSV: peak systolic velocity, ICA: internal carotid artery, AcT: acceleration time ICA Fig. 3 4 arrow ICA near occlusion Fig. 3 4 arrow head AcT 110 msec cut off ROC NASCET NASCET NASCET Fig AcT 138.5±26.3 msec 91.0±24.7 msec AcT P<0.01 AcT r=0.70 P<0.01 Fig. 6 Fig. 7 ICA AcT 122 msec 60 AcT 考察 CEA CAS NASCET NASCET ECST European Carotid Surgery Trial PSV PSV 8 NASCET PSV 150 cm/sec NASCET 50 PSV 200 cm/ sec NASCET 70 3, 9 PSV AcT ICA 368 脈管学 Vol. 51 No. 3
5 2 Figure 5 Sensitivity and Specificity of AcT. A: In the receiver operating characteristic (ROC) curve, when the cutoff value of the AcT was set at 110 ms, the sensitivity was 58.1% and the specificity was 88.2% for an ICA stenosis of more than 50% by the duplex NASCET method. B: The sensitivity was 94.7% and the specificity was 82.7% for an ICA stenosis of more than 60%. C: The sensitivity was 100% and the specificity was 75.9% for an ICA stenosis of more than 70%. A B C Figure 6 Relationship between degree of stenosis by the angiographic NASCET method and AcT (r=0.70, P<0.01). AcT 2 AcT PSV AcT 110 msec NASCET 60 PSV 170 cm/sec ROC AcT 110 msec cut off NASCET 60 NASCET 60 CEA 1 September 25,
6 Figure 7 A: Color Doppler image shows ICA origin. The evaluation of ICA origin is difficult due to the calcification of the vessel wall (arrow). B: Doppler waveform shows post-stenotic pattern. AcT is 122 ms. C: Lateral view of a left common carotid angiogram shows 80% ICA stenosis by the NASCET method (arrow). AcT ICA ICA AcT aortic stenosis; AS AS common carotid artery; CCA vertebral artery; VA AcT 10 AcT AS ICA AcT CCA AcT AcT ratio AcT ratio AcT ratio 1.5 NASCET NASCET AS AS AS AcT ICA acceleration AcT cut off AcT AcT AcT 370 脈管学 Vol. 51 No. 3
7 2 結論 AcT ICA AcT ICA 文献 , Neurosonology 2006; 19: ; 44: Burdick L, Airoldi F, Marana I, et al: Superiority of acceleration and acceleration time over pulsatility and resistance indices as screening tests for renal artery stenosis. J Hypertens 1996; 14: North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: Cremonesi A, Setacci C, Bignamini A, et al: Carotid artery stenting: first consensus document of the ICCS-SPREAD joint Committee. Stroke 2006; 37: Hankey GJ, Warlow CP, Sellar RJ: Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990; 21: Sabeti S, Schillinger M, Mlekusch W, et al: Quantification of internal carotid artery stenosis with duplex US: comparative analysis of different flow velocity criteria. Radiology 2004; 232: Koga M, Kimura K, Minematsu K, et al: Diagnosis of internal carotid artery stenosis greater than 70% with power Doppler duplex sonography. AJNR 2001; 22: O Boyle MK, Vibhakar NI, Chung J, et al: Duplex sonography of the carotid arteries in patients with isolated aortic stenosis: imaging findings and relation to severity of stenosis. AJR 1996; 166: Neurosonology 2009; 22: Usefulness of Acceleration Time for Internal Carotid Artery Origin Stenosis Hirokazu Tamura, 1 Yasuhisa Akaiwa, 2 and Kiyoshi Onda 3 1 Department of Medical Radiology, Niigata Neurosurgical Hospital, Niigata, Japan 2 Department of Neurology, Niigata University Medical and Dental Hospital, Niigata, Japan 3 Department of Neurosurgery, Niigata Neurosurgical Hospital, Niigata, Japan Key words: acceleration time, internal carotid artery, ultrasonography Calcification of a stenotic internal carotid artery (ICA) hinders accurate evaluation of the stenosis by conventional sonography due to acoustic shadow. We examined the relationship between ICA origin stenosis and acceleration time (AcT). 137 samples (266 vessels) that enforced duplex ultrasonography in our hospital were targeted. The results have shown that there is a significant relationship between stenosis and AcT. An AcT of more than 110 ms suggests that the stenosis is more than 60% by the NASCET method. AcT is thought to be useful for the diagnosis of ICA stenosis. (J Jpn Coll Angiol, 2011, 51: ) September 25, 2011 Online publication October 3,
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19 83 7 18 628 1 19 8 3 7 18 6 28 30 MI 31 360 21700BZY00247000 5mm CEA 59 mm 2 50% 80 1. 2. 3 19 8 3 [ ] 7 [ ] [ ] [ ] [ ] 18 6 28 [ ] CEA 49mm 50 80 2 4 carotid endarterectomy CEA 1,2 CEA ECST 3 NASCET
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