基于Mimics三维重建对下肢动脉硬化闭塞症诊疗的应用研究

目的评估基于Mimics三维重建对下肢动脉硬化闭塞症(LEASO)诊疗的有效性和准确性。方法收集河南大学第一附属医院心血管外科2020年1月至2023年3月70例LEASO患者的下肢动脉增强薄层CT及数字减影血管造影(DSA)检查资料, 用Mimics软件进行下肢动脉及斑块三维建模, 以CT血管造影(CTA)和DSA数据为参照, 比较Mimics软件和DSA评估的动脉节段狭窄程度分级、中度及以上狭窄动脉诊断一致率、病变长度、支架直径、外周动脉钙化评分系统(PACSS)分级的情况, 比较Mimics和CTA评估的钙化斑块体积、混合斑块钙化百分率的情况。结果与DSA结果相比, Mimics诊断动脉狭窄程度的符合率94.29%(792/840), 高估率3.81%(32/840), 低估率1.90%(16/840), 其中对狭窄程度≥50%动脉节段诊断灵敏度为97.19%(311/320), 特异度为98.08%(510/520), 假阳性率为1.92%(10/520), 假阴性率为2.81%(9/320), 准确率为97.74%(821/840), Kappa值为0.952。Mimics和...     

计算机断层扫描血管造影在颈动脉狭窄和颈动脉粥样硬化斑块形态评估中的应用价值

目的 探讨计算机断层扫描血管造影（CTA）在颈动脉狭窄和颈动脉粥样硬化斑块形态评估中的应用价值。方法 收集2020年7月至2021年7月于航空总医院80例经初步检查拟诊为颈动脉狭窄患者的临床资料。所有患者均接受CTA、数字减影血管造影（DSA）检查。以DSA检查结果为诊断颈动脉狭窄及其严重程度的金标准,分析CTA检查对颈动脉狭窄的诊断效能（灵敏度、特异度、准确度）,并分析其与DSA检查结果之间的一致性。结果 在80例经初步检查拟诊为颈动脉狭窄的患者中,共检查316段血管节段,DSA检查结果证实,发生颈动脉狭窄患者67例,共112段血管节段;未发生颈动脉狭窄患者13例,共204段血管节段。轻度、中度、重度狭窄及闭塞患者中检出的血管节段数量分别为34段、50段、20段、8段。CTA检查结果显示,发生颈动脉狭窄和未发生颈动脉狭窄患者分别为65例、15例。CTA诊断颈动脉狭窄的准确度、灵敏度、特异度分别为96.25%(77/80)、97.01%(65/67)、92.31%(12/13)。CTA与DSA检查对颈动脉狭窄及其严重程度的诊断结果高度一致（Kappa=0.866、0.914,P<...     

超声造影检查联合麦默通微创旋切系统活检在乳腺结节中的诊断应用

目的探究超声造影检查联合麦默通微创旋切系统活检在乳腺结节患者诊断及临床应用的意义。方法选取本院取2019年至2020年收治的乳腺结节患者68例。随机分为两组,观察组采用评估超声造影检查结合麦默通微创旋切系统活检(34例),对照组组普通超声结合空心针穿刺活检(34例)。比较两组诊断灵敏度、特异度及准确率;并发症发生率;与病理诊断分级一致率;临床疗效。结果观察组的特异度为94.12%、灵敏度为93.3%、准确度为88.23%。对照组的特异度为77.78%,灵敏度为81.25%,准确度为79.41%。观察组并发症总发生率低于对照组。观察组与病理结果一致率为97.06%;不一致率为2.94%。对照组一致率为88.24%;不一致率为11.76%。观察组总有效率为94.1%。对照组有效率为97.06%,无统计学显著差异。结论超声造影联合麦默通微创旋切系统在乳腺结节患者的诊断与治疗方面具有理想的临床意义。     

MRA与DSA在椎动脉型颈椎病诊断中的应用比较

目的对比椎动脉磁共振造影(magneticresonanceangiography,MRA)与数字减影血管造影(digitalsubtractionangiography,DSA)诊断椎动脉型颈椎病的意义。方法自2001年11月至2004年2月,共收集临床诊断为椎动脉型颈椎病的患者35例,男11例,女24例;年龄23～76岁,平均58.3岁。同时行MRA及DSA检查,观察椎动脉的走行、管径、是否存在狭窄及狭窄部位等。结果DSA检查有阳性发现者32例,其中单侧椎动脉受累19例,双侧受累13例。MRA有阳性发现者29例,其中单侧椎动脉受累14例,双侧受累15例。除5例MRA阳性而DSA阴性外,其他MRA与DSA均为阳性。两种方法对管腔变细的诊断吻合率为100%。DSA对局限性狭窄及单侧缺如的诊断优于MRA。MRA对颈椎不稳及增生导致的椎动脉迂曲变形等表现的诊断阳性率高于DSA。结论(1)椎动脉DSA检查对局限性压迫及动力性压迫的诊断较准确,对椎动脉压迫来源较易作出判断,检查中可变换体位。缺点是为有创检查,存在造影剂副反应及用量的限制。(2)MRA为无创检查,容易诊断弥漫性、长节段狭窄及闭塞,对合并其他类型颈椎病患者较适用。可同时扫描颈椎间盘、脊髓及颈部其他血管,以进行鉴别诊断。适用于临床诊断不明确、高龄不能耐受DSA检查的患者。MRA的不足之处是对局部微小部位的狭窄或非闭塞性病变的诊断率低,检查中无法随时变换体位。     

超声引导下穿刺活检联合超声造影在甲状腺结节良恶性诊断中的价值

目的 探索超声引导下穿刺活检联合超声造影在甲状腺结节良恶性诊断中的价值。方法 回顾性分析于2019年6月至2021年12月在本院行因各种原因行甲状腺结节切除术的患者66例的资料。所有患者均接受术前甲状腺超声造影、穿刺活检。以术中冰冻切片作为金标准，分别比较超声造影和穿刺活检的特异度、灵敏度和曲线下面积。以术中冰冻病理切片为金标准，将患者分为恶性组和良性组，比较两组患者的超声造影的影像学特征及差异。结果 66例患者共计检出87个甲状腺结节，含21例恶性（29个结节），45例良性（58个结节）。超声造影的特异度和灵敏度分别为68.97%(40/58)和72.41%(21/29)；穿刺活检的特异度和灵敏度分别为81.03%(47/58)和82.76%(24/29)；两者联合的特异度和灵敏度分别为94.83%(55/58)和96.55%(28/29)。各项检查方式之间的灵敏度和特异度差异均显著，P<0.05。良性结节和恶性结节的造影结果也存在显著差异（P<0.05）。结论 超声引导下穿刺活检联合超声造影对甲状腺结节良恶性鉴别诊断的价值较高，值得临床推广。     

肝移植术后肝动脉狭窄的多普勒超声最佳临界值确定及对小慢波患者临床决策作用的研究

目的分析多普勒超声(DUS)诊断肝移植术后肝动脉狭窄(HAS)的最佳临界值,并结合肝功能异常,提出小慢波(TPW)患者接受CT血管造影(CTA)或数字血管造影(DSA)检查的诊断标准。方法收集171例行肝移植术并在术后常规复查DUS、肝功能检查并行CTA或DSA检查确诊患者的临床资料。采用多水平似然比(MLR)确定肝动脉阻力指数(RI)及收缩期加速时间(SAT)诊断HAS的最佳临界值。建立不同诊断标准(低信心类为TPW阳性,中等信心类为TPW阳性+肝功能异常;高信心类为TPW阳性+肝功能异常或TPW阳性+最佳临界值)并比较其诊断效能。结果 MLR显示诊断HAS的最佳临界值为RI0.4,SAT0.12 s。中等信心类及高信心类诊断标准的特异度明显高于低信心类(P0.05),且假阳性率明显降低(P0.05)。另外,中等信心类诊断标准的灵敏度明显低于低信心类及高信心类(P0.05),而低信心类与高信心类诊断标准间的灵敏度差异无统计学意义(P0.05)。结论对于肝移植术后DUS检查显示TPW阳性的患者,结合肝功能异常及最佳临界值这一诊断标准可帮助临床医师对其作出适当的临床决策。     

肝移植术后早期及晚期肝动脉血栓的超声造影鉴别诊断

目的探讨超声造影对肝移植术后早期及晚期肝动脉血栓(HAT)的鉴别诊断价值。方法选取中山大学附属第三医院2004年10月至2011年12月彩色多普勒超声检查或临床疑诊HAT的肝移植术后患者64例,入院后经临床观察、数字减影血管造影(digital subtraction angiography,DSA)和(或)计算机断层摄影术血管成像(CTangiography,CTA),予超声随访并且具备完整的超声造影资料。64例疑诊HAT患者分为早期组(<30d,18例)和晚期组(≥30d,46例)两组。以临床表现、DSA和(或)CTA、超声随访等作为确诊HAT的参考标准,早期HAT组和晚期HAT组患者的HAT诊断时间、超声造影与参考标准所用检查的时间差用全距(中位数)表示,分别计算超声造影诊断早期HAT和晚期HAT的敏感度、特异度、准确度(总符合率)。结果早期组HAT的诊断时间为术后5～23d(中位数13d);晚期组HAT的诊断时间为术后30～1800d(中位数156d)。超声造影与参考标准所用检查的时间差为0～129d(中位数6.5d),10例超过30d。早期HAT的超声造影表现为动脉期、静脉期早期肝内动脉均未见显示。超声造影诊断早期HAT的敏感度、特异度、准确度分别为100%(8/8)、100%(10/10)、100%(18/18)。晚期HAT的超声造影表现为肝外肝动脉显示不正常,肝门部细小迂曲的侧枝动脉形成,肝内动脉均可见显示。超声造影诊断晚期HAT的敏感度、特异度、准确度分别为100%(9/9)、97%(36/37)、98%(45/46)。晚期组1例肝动脉狭窄误诊为HAT,此例肝门部有丰富的侧枝动脉。结论超声造影可以清晰显示肝动脉,对早期HAT诊断明确,对晚期HAT的诊断价值稍逊于早期HAT,侧枝动脉丰富是影响诊断晚期HAT准确性的因素之一。     

床旁超声心动图与计算机断层扫描血管造影在主动脉夹层中的诊断价值

目的 探讨床旁超声心动图与计算机断层扫描血管造影（CTA）在主动脉夹层诊断中的诊断价值。方法 收集2015年1月至2021年12月于首都医科大学附属北京朝阳医院怀柔医院就诊的67例疑似主动脉夹层患者的临床资料,均进行床旁超声心动图、CTA、数字减影血管造影（DSA）检查,比较床旁超声心动图、CTA及两者联合检测主动脉夹层的准确度以及主动脉夹层破裂口、血栓、心包积液检出情况。结果 67例疑似主动脉夹层患者中,47例经DSA确诊为Stanford A型主动脉夹层（阳性）,其他20例为阴性。两者联合检测主动脉夹层的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于单纯床旁超声心动图、CTA检查。床旁超声心动图、CTA及两者联合诊断主动脉夹层分型的准确度分别为82.09%、94.03%、100%,两者联合诊断主动脉夹层分型的准确度均高于单纯床旁超声心动图及CTA,差异均有统计学意义（P﹤0.05）。DSA检查示主动脉夹层破裂口67例,血栓35例,心包积液21例,床旁超声心动图联合CTA对主动脉夹层破裂口、血栓、心包积液的检出率均高于单独检测,差异均有统计学意义（P﹤0.05）。随访3个月后,...     

超声造影在移植肾血管并发症中的应用价值

目的评价超声造影(CEUS)在移植肾血管并发症中的应用价值。方法回顾性分析临床怀疑有移植肾血管并发症的28例肾移植患者的普通超声和CEUS图像资料,以CT血管造影(CTA)或数字减影血管造影(DSA)为诊断标准,分析CEUS在移植肾血管并发症中的诊断价值。结果 28例患者均未发生造影剂相关不良反应。22例确诊发生血管并发症。CEUS正确诊断血管并发症17例,漏诊5例移植肾动脉狭窄,误诊1例移植肾局灶性梗死。CEUS诊断移植肾血管并发症的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.77、1.00、1.00、0.55及0.82。普通超声及CEUS诊断移植肾动脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.37和0.74,0.89和1.00,0.88和1.00,0.40和0.64,0.54和0.82。两者灵敏度、准确度比较差异均有统计学意义(均为P0.05)。结论 CEUS是诊断移植肾血管并发症的有效手段。     

超声造影结合细针穿刺活检对乳腺癌前哨淋巴结的诊断效率

目的探讨超声造影结合细针穿刺对乳腺癌前哨淋巴结(SLN)的诊断价值。方法回顾性分析2015年12月至2019年12月行手术切除术80例单发乳腺癌患者资料,对所有患者术前进行超声造影和细针穿刺活检,以术后病理诊断结果为金标准,采用SPSS 20.0对数据进行分析,灵敏度、特异度、准确度等计数资料采用配对χ~2检验。绘制二者联合检测对SLN诊断的ROC曲线,并计算其曲线下面积(AUC)。以P0.05为差异有统计学意义。结果经病理诊断,腋窝淋巴结阳性率为91.3%(73/80)。超声造影检查腋窝淋巴结转移67例,阴性13例。诊断准确度为87.5%(70/80),灵敏度为89.0%(65/73),特异度为71.4%(5/7)。细针穿刺活淋巴引流区常规操作手术域检结果显示,有63例患者诊断为阳性,阴性17例。诊断准确度为82.5%(66/80),灵敏度为83.6%(61/73),特异度为71.4%(5/7)。二者联合检淋巴引流区常规操作手术域测结果显示,有71例患者诊断淋巴引流区常规操作手术域为阳性,阴性9例。诊断准确度为92.5%(74/80),灵敏度为94.5%(69/73),特异度为71.4%(5/7)。二者联合检测的其AUC(0.891)明显大于单独超声造影的AUC(0.835)与单独细针穿刺活检的AUC(0.758)(P0.05)。结论超声造影结合细针穿刺活检能够提高对乳腺癌SLN诊断的准确度和灵敏度,具有较高的诊断价值,值得在临床上推广应用。     

CTA、MRA诊断脑动静脉畸形:与DSA比较

目的比较CTA、MRA与DSA对脑动静脉畸形（AVM）的诊断价值。方法回顾性分析经DSA确诊为脑AVM的48例患者的脑CTA及MRA图像,并统计其诊断效率。结果27例患者接受颅脑CTA检查,7例大型脑AVM（直径〉6cm）与DSA结果一致,12例中型脑AVM（直径3-6cm）中1例CTA未检出,8例小型脑AVM（直径〈3cm）中CTA漏诊3例,CTA与DSA检查结果的差异有统计学意义（P〈0．05）。对21例患者行MRA检查,其中14例大、中型脑AVM（直径≥3cm）MRA诊断结果与DSA一致,7例小型脑AVM（直径〈3cm）中MRA漏诊4例,与DSA检查结果的差异有统计学意义（P〈0．05）。结论CTA、MRA诊断大、中型脑AVM与DSA基本相符,而对于小型脑AVM的诊断效率较低。     

Screening for blunt cerebrovascular injury: evaluating the accuracy of multidetector computed tomographic angiography

BACKGROUND: Digital subtraction angiography (DSA) has been widely considered the "gold standard" for diagnosing blunt cerebral vascular injury, but recent advances in multidetector computed tomographic angiography (CTA) may have led to improved accuracy compared with DSA. METHODS: A retrospective study of patients who underwent CTA and DSA for suspected blunt cerebral vascular injury was performed. Two neuroradiologists and one radiology resident, blinded to the other test, independently reviewed CTA and DSA studies. Sensitivity and specificity of CTA were determined using DSA as the gold standard. RESULTS: Thirty-two patients met the study criteria. Consensus DSA interpretation identified 17 vascular injuries in 15 patients. Among the three radiologists, the sensitivity of CTA for carotid injury ranged from 83% (10 of 12) to 92% (11 of 12), and the specificity ranged from 88% (36 of 41) to 98% (40 of 41). The sensitivity for vertebral artery injury ranged from 40% (2 of 5) to 60% (3 of 5), and the specificity ranged from 90% (35 of 39) to 97% (38 of 39). CTA sensitivity rose to 80% (four of five) in the vertebral artery when a lower diagnostic threshold was used. CONCLUSION: The sensitivity of CTA for carotid artery injury at our center was higher than in previous studies. This might be attributable to the superior quality of multidetector CTA images. Our conclusions on CTA accuracy in the vertebral artery are limited by the small number of injuries.     

Overestimation of carotid artery stenosis with magnetic resonance angiography compared with digital subtraction angiography

BACKGROUND AND PURPOSE: Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) is generally considered to overestimate the degree of stenosis in the internal carotid artery (ICA) in comparison with the reference standard intraarterial digital subtraction angiography (DSA). We evaluated whether the degree of stenosis was more accurately assessed with 3D TOF MRA if corresponding projections on MRA and DSA were compared instead of comparison of maximal stenosis at MRA with maximal stenosis at DSA. METHODS: From February 1997 to December 1999, we included 186 symptomatic and 17 asymptomatic consecutive patients suspected of having carotid artery stenosis on the basis of clinical presentation and screening with duplex ultrasound scan examination. All patients subsequently underwent DSA and MRA imaging. From each ICA, 12 maximum intensity projections with 3D TOF MRA and two or three projections with DSA were obtained. First, we compared the maximal stenosis at MRA with the maximal stenosis at DSA. Subsequently, we used the stenosis at MRA measured on the projection corresponding with the DSA projection that showed the maximal stenosis. For both strategies, the mean differences in stenosis and sensitivity and specificity for assessment of severe stenosis (70% to 99%) were calculated and compared. RESULTS: The MRA and DSA images of 354 ICAs could be compared. The sensitivity and specificity of MRA with the projection that showed the maximal stenosis were 92.6% (95% CI, 85.3% to 97.0%) and 82.7% (95% CI, 78.1% to 87.3%), respectively. The sensitivity and specificity with the MRA projection, corresponding with the DSA projection showing the maximal stenosis, were 88.3% (95% CI, 81.8% to 94.8%) and 89.6% (95% CI, 85.9% to 93.3%), respectively. The mean difference between maximal stenosis at MRA and DSA was 7.5% (95% CI, 5.2% to 9.9%). The mean difference between stenosis at MRA and DSA in corresponding projections was 0.4% (95% CI, -2.0% to 2.7%). CONCLUSION: If corresponding MRA and intraarterial DSA projections are compared, 3D TOF MRA does not overestimate carotid stenosis.     

Imaging Modalities for Renal Artery Stenosis in Suspected Renovascular Hypertension: Prospective Intraindividual Comparison of Color Doppler US,CT Angiography,GD-Enhanced MR Angiography,and Digital Substraction Angiography

The aim of the study was to evaluate the diagnostic accuracy of Color Doppler US, CT Angiography (CTA), and GD-enhanced MR Angiography (MRA) compared with digital subtraction angiography (DSA) for the detection of renal artery stenosis in patients with clinically suspected renovascular hypertension. Fifty-eight patients with suspected renovascular hypertension were enrolled in the study. All patients underwent Color Doppler US, CTA and GD-enhanced MRA. DSA was the gold standard method for the number of renal arteries, existence and degree of stenosis, or evidence of fibromuscular dysplasia. DSA depicted 132 renal arteries, 16 stenoses, and 4 arteries with fibromuscular dysplasia. Color Doppler US failed to detect 1 main and 14 polar arteries. CTA depicted all main renal arteries and 7/16 polar arteries, but failed to detect stenosis in two accessory vessels. Likewise, MRA did not detect stenotic accessory renal arteries, depicted 9/16 polar renal arteries, but missed two main renal arteries. All methods depicted the four main renal arteries with fibromuscular dysplasia. The overall sensitivity, specificity, and positive and negative predictive accuracy were 75%, 89.6%, 60% and 94.6%, respectively, for color Doppler US; 94%, 93%, 71%, and 99%, respectively, for CTA; and 90%, 94.1%, 75%, and 98%, respectively, for GD-enhanced MRA. CTA and GD-enhanced MRA have comparable and satisfactory results with respect to the negative predictive accuracy of the suspected renal artery stenosis. The concept of an imaging algorithm including US as screening test when appropriate and CTA or MRA as the second step-procedure is suggested. Therefore, DSA may be reserved for cases with major discrepancies or therapeutic interventions.     

Imaging modalities for renal artery stenosis in suspected renovascular hypertension: prospective intraindividual comparison of color Doppler US, CT angiography, GD-enhanced MR angiography, and digital substraction angiography

The aim of the study was to evaluate the diagnostic accuracy of Color Doppler US, CT Angiography (CTA), and GD-enhanced MR Angiography (MRA) compared with digital subtraction angiography (DSA) for the detection of renal artery stenosis in patients with clinically suspected renovascular hypertension. Fifty-eight patients with suspected renovascular hypertension were enrolled in the study. All patients underwent Color Doppler US, CTA and GD-enhanced MRA. DSA was the gold standard method for the number of renal arteries, existence and degree of stenosis, or evidence of fibromuscular dysplasia. DSA depicted 132 renal arteries, 16 stenoses, and 4 arteries with fibromuscular dysplasia. Color Doppler US failed to detect 1 main and 14 polar arteries. CTA depicted all main renal arteries and 7/16 polar arteries, but failed to detect stenosis in two accessory vessels. Likewise, MRA did not detect stenotic accessory renal arteries, depicted 9/16 polar renal arteries, but missed two main renal arteries. All methods depicted the four main renal arteries with fibromuscular dysplasia. The overall sensitivity, specificity, and positive and negative predictive accuracy were 75%, 89.6%, 60% and 94.6%, respectively, for color Doppler US; 94%, 93%, 71%, and 99%, respectively, for CTA; and 90%, 94.1%, 75%, and 98%, respectively, for GD-enhanced MRA. CTA and GD-enhanced MRA have comparable and satisfactory results with respect to the negative predictive accuracy of the suspected renal artery stenosis. The concept of an imaging algorithm including US as screening test when appropriate and CTA or MRA as the second step-procedure is suggested. Therefore, DSA may be reserved for cases with major discrepancies or therapeutic interventions.     

经颅多普勒超声转颈试验在颈性眩晕诊断中的应用价值

目的探讨经颅多普勒超声（transcranial Doppler sonography,TCD）转颈试验在颈性眩晕诊断中的价值。方法选择头晕患者133例,其中颈性眩晕（观察组）67例,其他眩晕（对照组）66例。所有患者均行颈椎X线、MRI和椎动脉磁共振血管造影术以及TCD常规检查和TCD转颈试验。结果 2组患者的颈部外伤病史、骨质增生、颈椎曲度异常、颈椎不稳、椎间盘突出的异常百分比无显著差异,颈痛和磁共振血管造影术椎动脉受压百分比差异有统计学意义（P〈0.05）。2组患者的常规TCD检测结果差异无统计学意义（P〉0.05）。观察组患者TCD转颈试验阳性率为80.60%（54/67）,对照组为4.55%（3/66）,2组间差异有统计学意义（P〈0.01）。结论 TCD转颈试验有助于颈性眩晕的诊断,可作为颈性眩晕诊断的一个客观指标。     

椎动脉磁共振血管成像对手法诊治椎动脉型颈椎病的研究

目的：探讨椎动脉磁共振血管成像（MRA）在椎动脉型颈椎病临床手法诊治中的重要作用,为椎动脉型颈椎病的临床诊治提供思路。方法：2007年5月至2010年12月,研究符合椎动脉型颈椎病诊断标准的患者（观察组,53例）和正常人（对照组,30例）的颈椎MRA中椎动脉走行及管径情况,其中观察组男19例,女34例;年龄26-72岁,平均（52．51±11．29）岁;对照组男10例,女20例;年龄25～70岁,平均（48．11±12．21）岁。比较两组受试者椎动脉走行及管径异常发生率的差异性,并结合X线、MRI、MRA资料对观察组的椎动脉走行及管径异常改变的因素及特点进行分析。结果：与对照组相比,观察组椎动脉走行及管径异常的发生率达81．13％（43／53）,两者比较差异有统计学意义（P=0．000）;且椎动脉走行及管径异常改变形式较复杂和多样化,其中以局部迂曲狭窄最为常见,累计占47．18％（25／53）;局部迂曲狭窄因素以椎间关节错缝为主,占43．41％（23／53）。结论：椎动脉型颈椎病患者容易发生椎动脉走行及管径异常改变,而MRA可有效诊断椎动脉的异常改变。     

256层螺旋CTA在左锁骨下动脉窃血综合征患者术前评估的价值

目的应用256层CTA技术观测左锁骨下动脉解剖特点,评价CTA对锁骨下动脉窃血综合征(SSS)介入治疗术前评估的应用价值。方法回顾性分析60例经临床确诊的SSS患者(疾病组)及500例无SSS受检者(对照组)左锁骨下动脉CTA资料,测量受检者左锁骨下动脉自主动脉弓的起始角度;评价疾病组左锁骨下动脉斑块的特点、管腔狭窄及闭塞情况。结果所有受检者左锁骨下动脉自主动脉弓的起始角度为:71.98°±8.26°,疾病组左锁骨下动脉起始角度71.98°的比例明显高于对照组,差异有统计学意义(P0.05)。疾病组左锁骨下动脉管腔闭塞11例(18.33%),闭塞范围为9~24mm;中度狭窄7例(11.67%),重度狭窄42例(70.00%),狭窄长度8~31mm;偏心性斑块33例,环形斑块16例。以DSA为金标准,CTA诊断左锁骨下动脉狭窄、闭塞的敏感度为96.77%,特异度为100%,诊断符合率为96.97%。结论 256层CTA可准确测量左锁骨下动脉的各项解剖数值;对左SSS术前评估具有重要的应用价值。     

Arterial endofibrosis in endurance athletes: Prospective comparison of the diagnostic accuracy of intra-arterial digital subtraction angiography and computed tomography angiography

PurposeTo prospectively compare the diagnostic capabilities of computed tomography angiography (CTA) to those of digital subtraction angiography (DSA) in endurance athletes with suspicion of arterial endofibrosis.Materials and methodsForty-five athletes (39 men, 6 women; median age: 30 years, interquartile range: 23–42 years) prospectively underwent DSA and CTA without (n = 5) or with (n = 40) electrocardiogram gating. DSA was interpreted by a single expert (experience of 15 years). CTA was independently interpreted by three other readers (experience of 5–8 years). Readers assessed the presence and degree of stenoses on iliac and femoral arteries and the overall diagnosis (negative, uncertain, positive) of endofibrosis at the limb level. Sensitivities and specificities of DSA and CTA were estimated at the limb level using histological findings and long-term follow-up as reference, and compared using the McNemar test.ResultsFor diagnosing and quantifying stenoses, concordance between DSA and CTA was moderate-to-good for common and external iliac arteries, moderate for lateral circumflex arteries and poor-to-moderate for the other branches of the deep femoral artery. It was good for all readers for the overall diagnosis of endofibrosis. After long-term follow-up (median, 95 months; interquartile range: 7–109 months), DSA sensitivity and specificity were respectively 88.6% (39/44; 95% confidence interval [CI]: 76–95%) and 75% (24/32; 95% CI: 57.9–86.7%); CTA sensitivity and specificity were respectively 88.6% (39/44; 95% CI: 76–95%; P > 0.99) and 84.4% (27/32; 95% CI: 68.2–93.1%; P = 0.51), 86.3% (38/44; 95% CI: 73.3–93.6%; P > 0.99) and 75% (24/32; 95% CI: 57.9–86.7%; P > 0.99), and 84.1% (37/44; 95% CI: 70.6–92.1%; P = 0.68) and 75% (24/32; 95% CI: 57.9–86.7%; P > 0.99) for the three readers.ConclusionCTA shows performances similar to those of DSA in predicting the long-term diagnosis of endofibrosis in endurance athletes with suggestive symptoms.