三维CT血管造影诊断血管性疾病的临床价值

目的 探讨三维CT血管造影（CTA）的应用范围及临床价值.方法 回顾性分析284例确诊为血管疾病的CTA资料,包括头颈血管组141例和躯干四肢血管组143例.扫描层厚为0.625 ～3.0 mm、螺距1.0～1.5,造影剂总量1.5 ～2.0 ml/kg.成像方法包括容积重建法（VR）、多层面重建法（MPR）、曲面重建法（CPR）、表面遮盖法（SSD）、最大强度投影法（MIP）及仿真内窥镜（VE）.诊断结果与数字减影血管造影（DSA）和/或手术对比.结果 进行2期CT螺旋扫描,实现心脏及全身血管三维成像,图像质量符合诊断要求.本组CTA诊断血管性疾病的敏感性、特异性、准确率分别为97.28％、82.35％、96.48％.CTA显示动脉瘤瘤体大小与DSA基本一致（P＞0.05）,但较手术测量小（P＜0.05）.结论 三维CTA适用于心脏及全身血管检查,可弥补常规CT检查的不足,具有诊断准确率高、无创伤的特点和部分替代创伤性DSA的潜力.

Clinical value of three-dimensional CT angiography in diagnosing blood vessel diseases

Objective To valuate the three-dimensional CT angiography(3DCTA) in diagnosing blood vessel diseases.Methods CTA findings of 284 patients confirmed with blood vessel diseases were retrospectively analyzed.They were divided into two groups:141 cases of head and neck and 143 cases of trunk and extremities.Scan was performed with the beam collimation of 0.625 ～ 3.0mm,increment of 0.3 ～ 1.4mm,pitch of 1.0 ～ 1.5,with the gross contrast medium of 1.5 ～ 2.0ml/kg.3D imaging methods included volume rendering(VR),multi-planar reformatting (MPR),curved planar reformatting(CPR),surface shade display(SSD),maximum intensity project(MIP) and virtual endoscopy(VE).The diagnostic results of CTA were compared with those of DSA and/or surgery.Results In this study,3D images of vasculature met the diagnostic criterion.The diagnostic sensitivity,specificity and accuracy of CTA was 97.28％,82.35％ and 96.48％,respectively.The size of artery aneurysm shown with CTA and DSA had no significant difference( P ＞0.05 ),both smaller than that in surgery( P ＜ 0.05 ).Conclusion 3DCTA could be used in diagnosing the cardiovascular diseases and compensate the limitation of conventional CT.It had the characteristics of non-invasion,high accuracy and could partly substitute DSA.