下肢动脉闭塞性病变的320层CTA与DSA对照研究

目的对照DSA，评价320层螺旋CT血管造影（CTA）对诊断下肢动脉闭塞性病变的临床应用价值。方法对30例下肢动脉闭塞性病变的患者行320层CTA及DSA检查。CT数据在东芝工作站处理，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，分析CTA与DSA结果。将肾动脉水平以下腹主动脉及单侧下肢动脉分为15个节段，本组病例共900节段，进行盲法评估。结果在全部900个动脉节段中，2种检查诊断Ⅲ及Ⅳ级病变准确率、灵敏度及特异度分别为98％、99％、98％。在评估主动脉、髂动脉节段的准确率、灵敏度及特异度分别为98%、100％、99％。在评估股动脉、胭动脉节段的准确率、灵敏度及特异度分别为98％、100％、99％。在评估胭动脉以下水平的动脉节段的准确率、灵敏度及特异度分别为98％、97％、99％。另有1个节段在320CTA显示不清，49个节段在DSA显示不清，无法评估。结论320层CT血管造影对下肢动脉闭塞性病变诊断准确率较高，较DSA能显示更多节段，可为制订介入治疗方案及临床治疗计划提供较准确的参考依据。

The comparative study of 320-slices spiral CT angiography with DSA in lower extremity arterial occlusive diseases

Objective To evaluate the clinical value of 320-slices spiral CTA with DSA comparatively in diagnosis of low er extremity arterial occlusive diseases. Methods Thirty consecutive patients with symptomatic extremity arterial occlu sive diseases were evaluated by both 320 MDCT and DSA. CT data were processed with Toshiba workstation of MIP, VR and MPR. We used step tracking technique or segmentation DSA in DSA detection. The aorto-iliac and lower extremity arteries were divided into 15 segments per limb. Nine hundred segments were analyzed in a blinded fashion by physicians. Results For all segments evaluated, the overall diagnostic accuracy for detecting grade III and IV lesions was 98% with a sensitivity of 99% and a specificity of 98% For the aorto-iliac segments, the diagnostic accuracy was 98% with a sensitiv ity of 100% and a specificity of 99%. For the femoropopliteal segments, the overall accuracy was 98% with a sensitivity of 100% and aspecificity of 99%. For the infrapopliteal segments, the overall accuracy was 98% with a sensitivity of 97% and a specificity of 99%. One segment could not be visualized by MDCT compared to 49 segments that could not be visual ized by DSA. Conclusion This study demonstrates excellent diagnostic accuracy of 320 MDCT in the detection of hemody namically significant disease of the lower extremities. More segments are visualized using 320 MDCT than DSA, allowing more complete visualization of the vascular tree. CT angiography should be considered in the diagnostic evaluation of symptomatic patients with peripheral vascular disease.