128层螺旋CT血管成像对下肢动脉硬化闭塞症的诊断价值

目的探讨128层螺旋CT血管造影(128-slice computed tomography angiography,128-SCTA)对下肢动脉硬化闭塞症(peripheral arterial occlusive disease,PAOD)的诊断价值。方法对56例临床怀疑下肢动脉硬化闭塞症的患者行128-SCTA检查,并进行多种方式的图像三维重组,将每例每侧下肢动脉分为11个节段,分析各段血管的显影质量和狭窄程度,以X线数字减影血管造影(DSA)诊断结果为参考标准,评估128-SCTA诊断下肢动脉狭窄的效度。结果所有128-SCTA和DSA图像均有诊断价值。128-SCTA显示97.4%血管的狭窄闭塞程度与DSA一致。128-SCTA诊断有血流动力学意义的下肢动脉狭窄(≥50%)的敏感性为99.6%,特异性为99.7%,准确度为98.6%,阳性预测值为99.6%,阴性预测值为99.7%。结论 128-SCTA可无创、准确地诊断PAOD,为治疗方案的制订及术后随访提供依据。

Diagnostic value of 128 slice computed tomography angiography for peripheral arterial occlusive diseases

Objective To investigate the diagnostic value of 128-slice computed tomography angiography（128-SCTA） for peripheral arterial occlusive disease（PAOD）.Methods 128-SCTA scanning was performed in 56 patients suspected of PAOD.CT data sets were transferred to workstation for imaging post-processing,including VR,MIP,CPR and vessel analysis.DSA was used as the reference standard.The common iliac arteries,the external iliac arteries,the internal iliac arteries,the common femoral arteries,the deep femoral arteries,the superficial femoral arteries,the popliteal arteries,the tibiofibular trunks,the anterior tibial arteries,the peroneal arteries,the posterior tibial arteries were assessed on the right and the lefts ides separately.All arterial segments were analyzed with regard to image quality and stenosis grade.The sen sitivity,specificity,positive and negative predictive values and accuracy for determination of significant arterial stenosis were calculated for all 22 segments together.Results All DSA and CTA studies were considered to be diagnostically con clusive.Rating of arterial visibility was significantly better with 128-SCTA techniques than that of DSA（P 0.05）.In all 128-SCTA findings,97.4% was consistent with conventional DSA.Compared with conventional DSA,the sensitivity,speci ficity,accuracy,positive predictive value,negative predictive value of 128-SCTA with regard to detection of hemodynamically significant stenosis（≥ 50%） in all 56 patients were 99.6%,99.7%,98.6%,99.6% and 99.7% respectively.Conclusion 128-SCTA is an accurate and reliable noninvasive means to identify PAOD,and is also useful for therapeutic planning and postoperative follow-up.