多层螺旋CT血管造影在颈动脉狭窄诊断中的应用

目的 数字减影血管造影(DSA)是诊断颈动脉血管狭窄的金标准,本研究旨在评价多层螺旋CT血管造影(CTA)对颈动脉狭窄的诊断价值及与DSA的吻合程度.方法 选择42例临床怀疑颈动脉狭窄患者行CTA和DSA检查,CTA后处理采用多维容积再现(volume rendering,VR)和最大强度投影(maximum intensity projection,MIP)技术,对血管狭窄程度进行分析.结果 CTA检查与DSA检查比较,颈动脉Ⅰ度狭窄的检出率间差异有统计学意义(χ2=4.71,P＜0.05),Ⅱ～Ⅳ度狭窄的检出率间差异无统计学意义(P＞0.05);CTA诊断颈动脉Ⅰ度狭窄的敏感度(Se)69.2%、特异度(Sp)95.3%、符合率(π)85.5%、误诊率(α)4.7%、漏诊率(β)30.1%;Ⅱ度狭窄的Se 82.1%、Sp 97.6%、π 91.3%、α 2.4%、β 17.9%;Ⅲ及Ⅳ度狭窄的Se 93.3%、Sp 98.1%、π 97.1%、α 1.9%、β 6.7%.结论 颈部血管CTA检查有较高的灵敏度和特异度,与DSA检查吻合程度好,是一种有效、安全、无创的检查手段,值得临床推广应用.

Diagnosis of Carotid Artery Stenosis by Multilayer Spire CT

Objective Digital subtraction angiography (DSA) is the gold criterion for the diagnosis of carotid artery stenosis,the purpose of this study is to assess the diagnostic value of the multilayer spire CT angiography (CTA) for carotid artery stenosis and its coincidence with DSA.Methods Totally 42 patients who were clinically suspected of having carotid artery stenosis (CAS) were examined by CTA and DSA,for CTA post treatment,volume rendering and maximum intensity projection technology was adopted.The degree of vascular stenosis was analyzed.Results The detection rate of grade Ⅰ carotid stenoses by CTA was significantly different from that by DSA (χ2=4.71,P＜0.05),but those of grade Ⅱ-Ⅳ carotid stenoses were not (P＞0.05).In the diagnosis of grade Ⅰ carotid stenosis by CTA the sensitivity (Se) was 69.2%,specificity (Sp) was 95.3%,total consistent rate (π) was 85.5%,misdiagnostic rate (α) was 4.7%,and omission diagnostic rate (β) was 30.1%.In the diagnosis of grade Ⅱ carotid stenoses by CTA,the Se was 82.1%,Sp was 97.6%,π was 91.3%,α was 2.4%,and β was 17.9%.In the diagnosis of grade Ⅲ-Ⅳ carotid stenoses by CTA,Se was 93.3%,Sp was 98.1%,π was 97.1%,α was 1.9%,and β was 6.7%.Conclusion CTA has higher sensitivity and Specificity for examination of carotid artery,it agrees well with DSA.It is an effective,safe and noninvasive examinational means,worth popularizing and applying in clinic.