64层螺旋CT血管成像对颈动脉分叉处病变的临床应用

目的探讨64层螺旋CT血管成像（CTA）在诊断颈内动脉狭窄和粥样硬化斑块中的价值，并与当前血管成像的金标准DSA进行比较。方法对40例病人（80个颈动脉）进行了CTA和DSA检查，两项检查时间间隔不超过1周，并将CTA与DSA结果进行对照，计算出两者之间的敏感度和特异度。结果CTA对轻度（狭窄程度：0-29％）颈动脉狭窄和颈动脉闭塞显示得非常好，其敏感度和特异度均接近100％。在明确经DSA测量狭窄程度〉50％的狭窄时，CTA敏感度、特异度分别为89％、91％。CTA在鉴别狭窄程度为50％-69％或70％～99％时的特异度高，而敏感度较低．分别为65％和73％。CTA同时可以检出DSA不能发现的所有类型的斑块。结论64层CTA在显示颈内动脉狭窄方面与DSA有很好的一致性，同时可发现与颈动脉狭窄相关的溃疡，而DSA只能显示狭窄。     

颅颈动脉狭窄的CTA与DSA对照研究

目的 :探讨64层颅颈联合CTA诊断颅颈动脉狭窄的临床应用价值。方法 :收集2012年9月到2014年9月在我院治疗的颅颈动脉狭窄患者75例,均行颅颈联合CTA及常规DSA造影。以DSA为金标准,评价颅颈联合CTA诊断颅颈动脉狭窄的敏感度和特异度;同时评价CTA与DSA在动脉狭窄程度评估上的一致性。结果:在动脉狭窄的检出率上CTA与DSA差异无统计学意义(P0.05),颅颈联合CTA诊断颅颈动脉狭窄的敏感度、特异度分别为88.9%、99.1%;在评价颅颈动脉狭窄程度上,CTA与DSA的一致性较好,K=0.843。结论 :64层颅颈联合CTA是可靠的血管成像方法 ,能较好地发现颅颈动脉狭窄,在评价颅颈动脉狭窄程度上与DSA有较好的一致性。     

64层螺旋CT的CTA和DSA在肾动脉狭窄研究中的应用

目的:探讨64层螺旋CTA和DSA在肾动脉狭窄的临床应用价值。方法:搜集临床拟诊为继发性高血压患者病例资料153例,行64层螺旋CTA检查,其中57例患者同时行DSA检查。将CTA与DSA结果进行对照,计算出二者之间的敏感度和特异度。结果:本组行CTA检查的153例患者中有71例肾动脉有不同程度的狭窄,57例行DSA检查的患者肾动脉均有不同程度的狭窄,CTA和DSA的敏感度和特异度为100%。结论:64层螺旋CT能清晰显示肾动脉系统的异常,在某些方面上可替代DSA检查。     

彩色多普勒与CTA在颈动脉血管支架置入术中的对比研究

目的：探讨双功能彩色多普勒（CDFI）和多层螺旋CT血管成像（MSCTA）在颈动脉狭窄血管内支架置入术中的应用价值。方法：回顾性分析行颈动脉支架置入的36例患者治疗前后的CDFI及MSCTA的影像资料,以DSA为标准,比较CDFI和MSCTA两种方法对颈部血管狭窄程度判断及粥样硬化斑块密度分析的符合率;比较这两种方法在颈动脉狭窄血管内支架置入术中的应用价值。结果：CDFI及MSCTA诊断颈动脉狭窄的敏感度分别为90.9%和92.8%,特异度分别为95.6%和95.7%,诊断符合率分别为92.4%和93.8%,阴性预测值分别为82.7%和86.5%,阳性预测值分别为97.8%和97.8%。MSCTA检出粥样动脉硬化斑块分型与CDFI的符合率为86.9%。结论：在颈动脉狭窄血管内支架置入术影像学检查中,CDFI可作为颈动脉病变筛查、术后疗效评价及随访的首选检查方法,MSCTA显示高位分叉的颈内动脉、颈内动脉入颅段及血管走向变异更有优势,两者结合可提高诊断符合率。     

64层螺旋CT对周围血管性疾病的诊断价值:与DSA的对照研究

目的 通过与DSA比较评估64层螺旋CT血管成像诊断周围血管性疾病(peripheral vascular disease,PVD)的准确性及特异性.方法 30例PVD患者同时接受DSA及CT血管造影检查.血管狭窄程度分为5级:Ⅰ正常(无狭窄);Ⅱ轻度狭窄(1%～49%狭窄);Ⅲ中度狭窄(50%～74%狭窄);Ⅳ重度狭窄(75%～99%);Ⅴ闭塞.以DSA结果为金标准,分析64层螺旋CT的灵敏度、特异度等指标.结果 30例患者中,共有720支血管均有DSA及CTA成像.进行分析比较后发现,64层螺旋CT诊断下肢动脉有意义狭窄的灵敏度98.5%、特异度99.2%、阳性预测值99.1%、阴性预测值98.7%.结论 64层螺旋CT血管成像是诊断周围血管狭窄程度的一种准确、安全、无创的影像学诊断技术.     

MRI和CTA在诊断颈动脉狭窄中的应用价值

目的探讨MRI和CT血管造影(CTA)在诊断颈动脉狭窄中的应用价值。方法选取我院行颈动脉狭窄检查的76例(共158处血管)患者作为观察对象,均具有MRI、CTA、数字减影血管造影(DSA)检查结果。结果 MRI颈动脉狭窄部位检出率为93.42%,且另发现4支血管具不稳定纤维帽,2支血管内出血;CTA检出率为98.68%,且另确定21处脂质斑块、17处混合斑块、39处钙化斑块,但MRI、CTA在狭窄部位检出率比较差异无统计学意义(P0.05)。MRI颈动脉狭窄符合度为92.41%,CTA为94.3%,MRI及CTA狭窄程度检出率比较差异无统计学意义(P0.05)。检查效能比较,MRI的准确度、特异度、敏感度分别为0.829、93.03%、92.78%、90.32%,CTA分别为94.03%、94.85%、91.92%,MRI、CTA检查效能比较差异无统计学意义(P0.05);诊断价值比较,MRI、CTA诊断效能均较高,曲线下面积(ACU)ACU分别为0.915、0.933,2者联合检查ACU进一步提高,为0.995。结论 MRI、CTA在颈动脉狭窄部位及狭窄程度上具有较高检出率。     

颈动脉斑块彩色多普勒超声联合头颈部CTA诊断缺血性脑卒中患者颈动脉狭窄临床价值

目的 探讨颈动脉斑块彩色多普勒超声(CDFI)联合头颈部CTA在缺血性脑卒中(IS)颈动脉狭窄检查中的临床价值。方法 选取80例IS患者，以DSA检查并根据血管狭窄程度分为轻度组25例、中度组30例和重度组25例，采用CDFI联合头颈部CTA对3组患者进行检查，观察各组斑块长度、斑块厚度以及斑块数量，并对斑块总面积、颈动脉内膜中层厚度(IMT)以及颈总动脉指数(CCA)、颈内动脉指数(ICA)、椎动脉指数(VA)进行比较。结果 经DSA检查显示共有102条狭窄血管，超声检查检出81条狭窄血管，CTA检出狭窄血管90条，超声检查联合CTA检出98条狭窄血管，中度组与重度组斑块总面积、IMT、斑块长度、斑块厚度、斑块数量、CCA、ICA、VA均高于轻度组，且重度组均高于中度组，差异具有统计学意义(P<0.05),颈动脉斑块CDFI与头颈部CTA联合检测的灵敏度、特异度以及准确率均高于单一检测，差异具有统计学意义(P<0.05)。结论 颈动脉斑块CDFI联合头颈部CTA对检查缺血性脑卒中患者颈动脉狭窄具有较高应用价值。     

64层螺旋CTA与DSA在颈内动脉狭窄研究中的应用

目的探讨64层螺旋CTA与DSA在颈内动脉狭窄的临床应用价值。方法收集临床拟诊为前循环缺血发作的患者203例,进行64层螺旋CTA检查,其中97例患者同时行DSA检查,并将CTA与DSA结果相对照,计算出二者之间的敏感性和特异性。结果本组行CTA检查的203例患者中有181例患者颈内动脉有不同程度的狭窄,97例行DSA检查的患者颈内的动脉均有不同程度的狭窄,CTA与DSA的敏感性和特异性为100%。结论64层螺旋CTA能够清晰地显示颈内动脉系统的异常,在某些方面上可替代DSA检查。     

下肢动脉闭塞性病变的64层CT血管造影与DSA的对照研究

目的对照DSA,研究64层螺旋CT血管造影(CTA)对下肢动脉闭塞性病变诊断的临床应用价值。方法对31例下肢动脉闭塞性病变患者行64层螺旋CTA检查,检查后2周内行DSA。CT数据重建采用最大密度投影、容积重建及多平面重建技术。DSA采用步进跟踪造影技术或分段DSA进行下肢血管检查,将CTA与DSA结果比较。结果在216个动脉节段中,2种检查方法狭窄程度显示一致的有157个,被CTA高估13个,低估6个。CTA对下肢动脉狭窄程度≥50%诊断的灵敏度为98.21%,特异度96.15%,准确率97.22%,阳性预测值96.49%,阴性预测值98.04%。结论64层CT血管造影是下肢动脉闭塞性病变评估的可靠方法,可为制订介入治疗方案提供准确的参考依据。     

CTA与DSA评估冠心病冠状动脉狭窄程度的临床价值

目的 探讨CT血管成像(CTA)与数字减影血管造影(DSA)评估冠心病(CHD)冠状动脉狭窄程度的临床价值。方法选取78例疑似CHD患者，首先行CTA检查，并在随后7天内行DSA检查。将DSA作为诊断金标准，分析CTA对冠状动脉阳性病变的诊断结果。结果 经DSA金标准诊断阳性65例，阴性13例，其中CTA诊断阳性64例，阴性12例。CTA对冠状动脉阳性病变诊断的阴性预测值为92.31%、阳性预测值98.46%、灵敏度98.46%、特异度92.31%、符合率97.44%,一致性分析Kappa值分别为0.890,0.932,0.890,0.932,0.928。DSA与CTA对CHD冠状动脉狭窄程度的检查结果比较，差异无统计学意义(P>0.05)。结论 CTA对于CHD具有较高的诊断价值，能够有效识别冠状动脉狭窄程度与斑块类型。     

CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography

BACKGROUND AND PURPOSE: To compare multisection CT angiography (CTA) analyzed with source/maximum intensity projection (MIP) images as well as semiautomated vessel analysis software with intra-arterial digital subtraction angiography (DSA) in detection and grading of carotid artery bifurcation stenosis. METHODS: Consecutive patients with sonography evidence of a marked internal carotid artery stenosis underwent both carotid CTA and DSA (37 patients, 73 vessels). In CTA, the grade of stenosis was determined using axial source and MIP images as well as vessel analysis. The scans were blind-analyzed by 2 neuroradiologists using the NASCET criteria. RESULTS: Correlation of CTA source/MIP images versus DSA estimates of stenosis (R = 0.95) was higher than for the vessel analysis method versus DSA (R = 0.89). Compared with DSA, CTA source/MIP images underestimated high (78.2% versus 86.4%, P < .05) and moderate grades of stenosis (57.3% versus 63.1%, P < .05) to a lesser extent than the vessel analysis method (68.5% versus 83.5% and 51.8% versus 63.1%, P < .05). For a high-grade stenosis, sensitivity and specificity of source/MIP image CTA were 75% and 96%, respectively, whereas for the vessel analysis method, they were 47% and 96%, respectively. For moderate stenosis, the source/MIP image CTA sensitivity and specificity were 88% and 82%, respectively, and for vessel analysis method, 62% and 82%, respectively. CTA detected all 4 occlusions. CONCLUSION: In evaluation of carotid stenosis, CTA provides an adequate, less invasive alternative with a high correlation to conventional DSA, though it tends to underestimate clinically relevant grades of stenosis. Its accuracy is not improved by semiautomated analysis. The data support the use of CTA in confirming carotid occlusion.     

64层CT血管造影诊断颈内动脉狭窄及内膜切除术或支架置入术后随访的价值

目的通过与DSA对比，评价64层容积CT血管造影（CTA）诊断颈内动脉（ICA）狭窄，及其在内膜切除术和支架置入术后随访中的价值。方法同时进行CTA和DSA检查的短暂性脑缺血患者40例，根据北美症状性颈内动脉内膜剥脱术实验（NASCET）的方法，由2名不了解患者情况的放射科主任医生分别对80支颈内动脉进行CTA的曲面重建和DSA测量。以远心端颈内动脉作为参考，以DSA为金标准，以狭窄率50％及70％为界计算CTA敏感度、特异度、阴性预测值和阳性预测值等。内膜切除术和支架置入术前、术后CTA测得的ICA狭窄处直径及横切面面积的比较用配对t检验。结果以狭窄率超过70％为标准，37支血管中35支DSA和CTA检查结果一致（95％），CTA的敏感度、特异度、阴性预测值和阳性预测值分别为97％[95％可信限（CI）为85％-100％]、95％（95％CI为82％-100％）、95％（95％CI为82％-100％）、98％（95％CI为92％-100％）。CTA检测内膜切除术和支架置入术后ICA狭窄处直径及横切面面积较术前有显著增加，差异有统计学意义（P〈0．01）。结论CTA是筛查ICA狭窄的一种有效手段，也可作为ICA内膜剥脱术和支架置入术后随访的首选方法。     

CTA和DSA应用于脑血管病变的比较

目的　将CTA与DSA对脑血管病变的检出进行对照 ,观察CTA在脑血管病变检出方面的价值。方法　选择自 1999-0 3～ 2 0 0 0 -0 82 0例脑血管病变患者行CTA和DSA检查 ,将CTA与DSA检出情况进行对比 ,观察CTA的敏感度和特异度 ,以及它们的符合率。结果　 2 0例患者经CTA检查发现有 17例患者存在血管异常 ,3例患者显示正常 ,存在血管异常的 17例患者共检出 18个脑血管病变 ,包括 6个动脉瘤 ,9个AVM ,2个颈内动脉 -海绵窦瘘 (CCF) ,1个动脉狭窄 ;DSA检查 17例患者存在血管异常 ,3例患者显示正常 ,存在血管异常的 17例患者共检出 19个病变 ,7个动脉瘤 ,8个AVM ,2个动脉狭窄 ,2个CCF。经统计得知 ,CTA检出脑血管病变的敏感度为 90 .6% ,特异度为 95 .2 % ,CTA与DSA的总符合率为 90 .6%。结论　我们认为三维CTA对于脑血管病变的检出 ,具有较高的敏感性和特异性 ,而且操作简单、方便、安全、微创伤性 ,能用于脑血管病变的诊断 ,并有其较高的临床应用价值。尤其是对AVM的检出率很高     

Preliminary experience with MRA in evaluating the degree of carotid stenosis and plaque morphology using high-resolution sequences after gadofosveset trisodium (Vasovist) administration: comparison with CTA and DSA

Purpose

The authors performed a preliminary study with blood-pool contrast-enhanced magnetic resonance angiography (MRA) in evaluating the degree of carotid artery stenosis and plaque morphology, comparing the diagnostic performance of first-pass (FP) and steady-state (SS) acquisitions with 64-slice computed tomography angiography (CTA) and using digital subtraction angiography (DSA) as the reference standard.

Materials and methods

Twenty patients with ≥50% carotid artery stenosis at Doppler sonography underwent blood-pool contrast-enhanced MRA, CTA and DSA. Two independent radiologists evaluated MRA and CTA examinations to assess the degree of stenosis and characterise plaque morphology. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FP, SS and CTA. The McNemar and Wilcoxon tests were used to determine significant differences (p<0.05) between the diagnostic performance of the three modalities.

Results

Forty carotid bifurcations were studied. For stenosis grading, accuracy, sensitivity, specificity, PPV and NPV were 90%, 89%, 90%, 89% and 90%, respectively, at FP; 95%, 95%, 95%, 95% and 95%, respectively, at SS; and 97.5%, 95%, 100%, 100% and 95%, respectively, at CTA. SS and CTA were superior to FP for evaluating the degree of stenosis (p<0.05). For evaluating plaque morphology, accuracy, sensitivity, specificity, PPV and NPV were 87.5%, 89%, 86%, 85% and 90%, respectively, at FP; 97.5%, 100%, 95%, 95% and 100%, respectively, at SS; and 100%, 100%, 100%, 100% and 100%, respectively, at CTA. There were no significant differences between FP, SS and CTA for plaque assessment (p>0.05).

Conclusions

Blood-pool contrast-enhanced MRA with SS sequences allow improved diagnostic evaluation of the degree of carotid stenosis and plaque morphology compared with FP and is substantially equal to CTA and DSA.     

16层螺旋CT在下肢动脉闭塞性疾病中的应用价值

目的:探讨16层螺旋CT血管成像术在诊断下肢动脉闭塞性疾病中的应用价值。方法:对42例临床疑为外周动脉闭塞性疾病的患者行下肢动脉16层螺旋CT血管造影(CTA),扫描范围从肾动脉水平达足底。薄层重建横断面图像传入HP xw8000工作站,进行血管三维重建。所有患者于CTA检查前或后2周内行数字减影血管造影(DSA)。以DSA为金标准,评价CTA诊断的准确性。结果:在882个动脉节段中,870个节段在CTA与DSA均可以显示,在DSA图像上,狭窄闭塞的节段共260个(轻度狭窄32段,中度狭窄24段,重度狭窄44段,闭塞160段),最大密度投影(MIP)显示中度以上狭窄的敏感性、特异性及准确性分别为99.1%、99.7%、99.5%。结论:16层螺旋CT在评估下肢动脉闭塞性疾病方面与常规血管造影结果无明显差别,是下肢动脉闭塞性疾病理想的影像学检查手段,可部分替代DSA检查。     

Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography

We evaluated quantification of calcified carotid stenosis by dual-energy (DE) CTA and dual-energy head bone and hard plaque removal (DE hard plaque removal) and compared the results to those of digital subtraction angiography (DSA). Eighteen vessels (13 patients) with densely calcified carotid stenosis were examined by dual-source CT in the dual-energy mode (tube voltages 140 kV and 80 kV). Head bone and hard plaques were removed from the dual-energy images by using commercial software. Carotid stenosis was quantified according to NASCET criteria on MIP images and DSA images at the same plane. Correlation between DE CTA and DSA was determined by cross tabulation. Accuracies for stenosis detection and grading were calculated. Stenosis could be evaluated in all vessels by DE CTA after applying DE hard plaque removal. In contrast, conventional CTA failed to show stenosis in 13 out of 18 vessels due to overlapping hard plaque. Good correlation between DE plaque removal images and DSA images was observed (r ² = 0.9504) for stenosis grading. Sensitivity and specificity to detect hemodynamically relevant (>70%) stenosis was 100% and 92%, respectively. Dual-energy head bone and hard plaque removal is a promising tool for the evaluation of densely calcified carotid stenosis.     

MR和CT血管造影在诊断颈动脉狭窄及内膜切除术后随访中的价值

目的 探讨磁共振血管造影（MRA）、CT血管造影（CTA）在诊断颈动脉狭窄及内膜切除术后随访中的价值。方法 11例22支颈动脉行MRA、CTA、CT仿真内窥镜（CTVE）、多普勒超声（DUS）检查。12支结果与DSA对照。3支颈动脉重度狭窄者行内膜切除术,MRA采用二维、三维时间飞越法。CTA经最大强度投影（MIP）及遮盖表现显示法（SSD）三维重建。应用导航功能行CTVE成像。结果 颈动脉轻度狭窄8支,中度狭窄3支,重度狭窄5支,闭塞1支,5支正常。12支颈动脉与DSA对照：CTA评估血管狭窄与DSA相符者11支,MRA与DSA相符者9支,DUS与DSA相符者7支。CTA、CTVE显示斑块、壁血栓6支,3支手术证实。术后MRA示狭窄解除,CTA示斑块消失。结论 MRA、DUS可用于颈动脉狭窄的筛选及术后随访。CTA评估血管狭窄程度与DSA、手术比较有较好的一致性,并能直接显示钙化斑块。     

Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler

OBJECTIVE: assessment of the degree of stenosis is the central point in the treatment of carotid stenosis. The purpose of our study was to assess whether invasive CT angiography (CTA) is a feasible alternative to the current invasive gold standard carotid digital subtraction angiography (DSA) and the current non-invasive gold standard color flow doppler. SUBJECTS AND METHODS: about 178 patients with cerebrovascular disease underwent digital subtraction angiography (DSA), CFD and CTA. CTA was performed on a Somatom plus 4 (Siemens, Erlangen Germany). CT was performed with 2/3/2 (collimation/table feed/reconstruction interval) or 2/3/1 mm, start delay 15-20 s, flow 2.5-3.0 ml/s, using 120 ml non-ionic contrast medium (300 mg J/ml). Quantification of degree of stenosis was based on the perfused area in the axial slices. Plaque morphology (soft and hard) and ulceration were evaluated. RESULTS: CTA detected nine cases of significant stenosis, which had been underestimated by DSA. CTA failed in two cases of a membraneous stenosis, which were underestimated, and in two cases with teeth artifacts. Calcifications were more readily appreciated by CTA than in CFD. In this respect, both methods were superior to DSA. CFD, DSA and CTA had a sensitivity of 100% for occlusions, respectively. CONCLUSION: CT angiography is useful in case of inconclusive CFD in the pre- and postoperative phase, and as a third modality in case of disagreement between DSA and CFD.