64层螺旋CT血管造影技术与多普勒超声在颈动脉内膜剥脱术中的应用价值

目的探讨64层螺旋CT血管造影技术(CTA)与多普勒超声(CDUS)在颈动脉内膜剥脱术中的应用价值。方法选取42例经数字减影血管造影(DSA)检查确诊的发生颈内动脉狭窄病变的缺血性脑血管患者,均接受颈动脉内膜剥脱术治疗,并于术前术后行CTA、CDUS检查评估颈内动脉狭窄病变改善情况。结果术前CTA诊断轻度、中度、重度狭窄及完全闭塞,准确率依次为100%、95.24%、85.71%、85.71%,其中轻度、中度、重度狭窄评估准确率均略高于CDUS,但差异无统计学意义(P0.05)。手术成功35例,失败7例,成功率83.33%。35例患者术前存在77个狭窄节段,CTA、CDUS检查均显示多数患者存在斑块,术后斑块均不同程度消失,部分节段轻微斑块残留;CTA可显示部分管壁表面可见溃疡,而CDUS难以清晰显示,术后可见可见溃疡基本消退;CDUS显示均可见血流动力学异常,存在血栓或发生夹层,术后血流速度趋于正常。术后CTA检查显示狭窄远端直径、最小残余直径显著大于术前(P0.05);术后CDUS检查显示PSV、EDV显著较术前减小(P0.05)。结论 CTA术前评估颈内动脉狭窄程度准确率更高,CTA与CDUS术前、术后在颈动脉内膜剥脱术中均有各自的评估特点,可联合应用于颈动脉内膜剥脱术的术前术后评估。

The Application Value of 64 Slice Spiral CT Angiography and Color Doppler Ultrasound in Carotid Endarterectomy

Objective To explore the application value of 64 slice spiral CT angiography (CTA) and color Doppler ultrasound (CDUS) in carotid endarterectomy.Methods A total of patients with ischemic cerebrovascular disease and carotid artery stenosis confirmed by digital subtraction angiography (DSA) underwent endarterectomy. CDUS and CTA were performed before and after operation to evaluate the relief of carotid artery stenosis. Results The accuracy rates of CTA in the diagnosis of mild, moderate and severe stenosis and complete occlusion were 100%, 95.24%, 85.71% and 85.71%, respectively. The evaluation accuracy rates of mild, moderate and severe stenosis were slightly higher than those of CDUS (P>0.05). The operation was successful in 35 cases and failed in 7 cases, and the success rate was 83.33%. There were 77 stenosis segments in 35 cases. Both of CTA and CDUS showed that the majority of patients had plaques, and after operation, plaques disappeared to different degrees. Some segments with mild plaques remained; CTA showed that there was ulcer on some tube walls while CDUS can not clearly show. After operation, the ulcer basically disappeared. CDUS showed hemodynamic abnormalities, with presence of thrombus or dissection. After operation, blood flow velocity tended to be normal. Postoperative CTA showed that the diameter and minimum residual diameter of the stenosis were significantly larger than those before operation (P<0.05). Postoperative CDUS showed that PSV and EDV were significantly smaller than those before operation (P<0.05).Conclusion The accuracy of CTA in preoperative evaluation of carotid artery stenosis degree is relatively higher. Both of CTA and CDUS have their own evaluation features in carotid endarterectomy. The combination of the two can be used for preoperative and postoperative evaluation of carotid endarterectomy.