DIJAGNOSTIČKI REZULTATI DUPLEKS ULTRASONOGRAFIJE ARTERIJE KAROTIS U PRIVATNIM ORDINACIJAMA GRADA ZAGREBA

ANDRIJA HEBRANG, TOMISLAV MAČEK, DRAGO JANUŠ, VINKO VIDJAK, ZORAN BRNIĆ, ANTE GRGA, MIRKO ŠRLIJA, DUBRAVKO HLEVNJAK

U radu se ispituje dijagnostička vrijednost dupleks ultrasonografije (DU) arterije karotis u bolesnika s cerebrovaskularnom insuficijencijom izvedene u dijelu privatnih liječničkih ordinacija grada Zagreba. Istraživanje je provedeno na svim pacijentima koji su u trogodišnjem razdoblju upućeni na digitalnu suptrakcijsku angiografiju (DSA) moždanih arterija, a prethodno su u procesu obrade podvrgnuti DU pregledu istih arterija u jednoj od privatnih ordinacija (ukupno 12 ordinacija). U tom razdoblju je na DSA upućeno 127 bolesnika (100 muških i 27 žena, dob 28–79 godina, srednja dob 62 godine života) na temelju DU izvedenog u privatnim ordinacijama. Pacijenti koji su DU imali u ostalim (neprivatnim) ordinacijama nisu predmet ovog istraživanja. Metoda ispitivanja je usporedba nalaza DU s nalazima DSA kao metode zlatnog standarda. Istraživanje su prospektivno obavila tri radiologa, koji prije izvođenja DSA nisu znali prethodni nalaz DU. Analizirani su patološki nalazi supraaortalnih arterija s posebnim osvrtom na značajne stenoze (70%–99%) ekstrakranijalnog dijela arterije karotis, obliteraciju i ulcerirane plakove. Rezultati pokazuju da je u otkrivanju značajnih stenoza arterije karotis koje su indikacija za kirurški zahvat ili PTA (stenoze od 70% do 99%) DU imao osjetljivost od samo 63%, specifičnost 79%, pozitivnu prediktivnu vrijednost 60% a negativnu prediktivnu vrijednost 81%. U razlikovanju obliteracije a. karotis interne od suptotalne stenoze DSA je prikazala 18 obliteracija, a DU 20, od čega je bilo 9 lažno pozitivnih nalaza i 7 lažno negativnih (osjetljivost 36%). Ulceraciju plaka DU je dijagnosticirao samo u 3 od 37 bolesnika, uz dva lažno pozitivna i 36 lažno negativnih nalaza. Dobiveni rezultati metodu DU primijenjenu u 12 ispitivanih privatnih ordinacija čine dijagnostički nepouzdanom, a cijenu izvođenja neopravdanim troškom. Moguće uzroke treba tražiti u nedovoljnoj edukaciji i manjkavoj regulaciji uvjeta pod kojima se može obavljati DU dijagnostika moždanih arterija

Summary. The purpose of the investigation was to evaluate the diagnostic value of duplex ultrasonography (DU) of thecerebral arteries in the patients with cerebrovascular insufficiency performed in private offices in Zagreb town. The investigation was performed for all patients referred to digital subtraction angiography (DSA) after Du examination performed in one of private offices (in total, 12 offices) during the period of three years. During mentioned period 127 patients were examined (100 male, 67 female, age 28–79 y, mean 62 y) according to DU exams performed in private offices. Other patients, who had DU examinations in offices other than private, were not examined in present investigation. The method of investigation was pro- spective comparison between DSA and DU findings, where DSA was used as the gold standard. The investigation was per- formed by three radiologists prospectively. They did not know DU findings before performing DSA. The pathological findings of the supraaortal arteries and especially significant stenoses (70%–99%) of the extracranial part of the carotid arteries, obliteration and ulcerated plaques were examined. For the significant stenoses of the carotid arteries, which are indication for operative treatment, DU showed sensitivity of only 63%, specificity 79%, positive predictive value 60% and negative predictive value 81%. The diagnostic difference between occlusion and subtotal stenosis of the carotid artery was also very important. DSA showed 18 occluded arteries, while DU presented 20, nine of them false positive and seven false negative (sensitivity 36%). DU diagnosed ulcerated plaque in only three out of 37 patients, including two false positive and 36 false negative results. According to results presented here, DU of the carotid arteries performed in analysed practices are not reliable and the price of DU presents expense without benefit. The insufficient education of the doctors and defective regulations of the private practices are the possible reasons for such results.