目的 研究TCD、MRA及与DSA诊 断缺血性脑血管病(ICVD)颅内动脉狭窄 的临床价值。方法 回顾性分析96例ICVD 患者的经颅多普勒超声(TCD)、磁共振血 管成像(MRA)、数字减影血管造影(DSA) 影像资料，以DSA检查结果为金标准，分 析其与TCD、MRA诊断ICVD颅内动脉狭窄 的临床价值。结果 共96例患者经DSA检 查检出56例颅内动脉正常、14例轻度狭 窄、8例中度狭窄、4例重度狭窄、14例 闭塞；TCD检出51例正常51例，12例轻度 狭窄，10例中度狭窄，6例重度狭窄， 17例闭塞；MRA检查共检出56例正常，13 例轻度狭窄，9例中度狭窄，6例重度狭 窄，12例闭塞；与DSA检查结果对照， TCD诊断颅内动脉是否狭窄的灵敏度、 特异度、准确率、阳性预测值、阴性预 测值分别为82.14%、87.50%、84.37%、 90.19%、77.77%，kappa值0.684；MRA 为89.28%、85.00%、87.50%、89.28%、 95.00%，kappa值为0.742；三种检查方 在灵敏度、准确率、阴性预测值上比较 差异有统计学意义(P＜0.05)，且TCD灵 敏度、阴性预测值显著低于MRA、DSA， 而MRA、DSA诊断颅内血管狭窄的灵敏 度、特异度、准确率、阳性预测值、阴 性预测值比较差异无统计学意义(P＞ 0.05)。结论 DSA是诊断IVCD颅内动脉狭 窄的“金标准”，对比DSA，TCD、MRA 在诊断ICVD颅内动脉狭窄上具良好一致 性，且MRA与DSA的一致性相对更佳。

Objective To study the clinical value of TCD, MRA and DSA in the diagnosis of intracranial artery stenosis in ischemic cerebrovascular disease (ICVD). Methods Imaging data of 96 cases of ICVD patients with transcranial Doppler ultrasound (TCD), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) were analyzed retrospectively. Set DSA results as the gold standard and analyze the diagnostic value of TCD, MRA in ICVD patients. Results A total of 56 cases of normal intracranial arteries, 14 cases were mild stenosis, 8 cases were moderate stenosis, 4 cases were severe stenosis, 14 cases of occlusion were detected by DSA, 51 cases were normal, 12 cases of mild stenosis, 10 cases of moderate stenosis, 6 cases of severe stenosis, 17 cases of occlusion were detected by TCD, 56 cases of normal, 13 cases of mild stenosis, 9 cases of moderate stenosis were detected by MRA. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of TCD were 82.14%, 87.50%, 84.37%, 90.19%, 77.77%, kappa value was 0.684, and for MRA were 89.28%, 85.00%, 87.50%, 89.28%, 95.00%, and kappa value was 0.742, respectively. The sensitivity and negative predictive value of TCD were significantly lower than those of MRA and DSA, but the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRA and DSA in the diagnosis of intracranial vascular stenosis had no significant difference. Conclusion DSA is the "gold standard" for the diagnosis of IVCD intracranial artery stenosis. Compared with DSA, TCD and MRA have good consistency in the diagnosis of ICVD intracranial artery stenosis, and MRA and DSA have better consistency..