CT血管造影对颈动脉粥样硬化性病变的诊断价值

目的 探讨CT血管造影(CTA)诊断颈动脉粥样硬化性病变的价值.方法 对92例前循环缺血发作患者行16层螺旋CTA检查,其中55例于CTA检查前后1周内进行了数字减影血管造影(DSA)检查,64例进行了彩色多普勒超声(CFDS)检查.CTA扫描横断面轴位图像应用三维重建技术作图像后处理,测量颅外段颈内动脉狭窄程度,统计颈动脉粥样硬化斑块,并分别与DSA和CFDS结果比较.结果 CTA与DSA对颅外段颈内动脉狭窄程度分级判断的一致性为90.9％(Kappa=0.87,P＜0.01),CTA对颅外段颈内动脉各级狭窄诊断的灵敏度、特异度、阳性预测值、阴性预测值均较高.CTA与CFDS在颈动脉的斑块检出率差异无统计学意义,两种检查方法共同判断的113处斑块的性质判定的一致性为77.9％(Kappa=0.67,P＜0.01).结论 CTA对颈动脉狭窄程度、粥样硬化斑块诊断有较高的准确性,可作为颈动脉粥样硬化性病变筛选的常规方法.

Clinical value of CT angiography in carotid artery atherosclerosis

Objective To assess the clinical value of 16-section spiral CT angiography(CTA) in carotid artery atherosclerosis.Methods CTA were performed on 92 patients with anterior circulation ischemia of cerebrum.Among them,55 patients had digital subtraction angiography(DSA) examinations and 64 also underwent color doppler Ultrasound(CFDS) within one week of CTA.The three-dimensional reconstruction was performed on the axial images obtained by CTA.The degrees of vascular stenosis and carotid atherosclerosis plaque detected by DSA and CFDS were compared with CTA.Results The consistent rate of CTA and DSA in detecting stenosis of extracranial internal carotid artery was 90.9%(Kappa=0.87,P<0.01).The sensitivity,specificity,positive and negative predictive value of CTA detecting carotid artery atherosclerosis were higher.There was no statistical significance between the detection rates of CTA and CFDS,and the consistent rate of the quality of 113 spot plaque judged by the two methods was 77.9%(Kappa=0.67,P<0.01).Conclusions CTA can accurately diagnose carotid stenosis,and evaluate atherosclerotic plaque,act as a routine for screening carotid artery atherosclerosis.