脑梗塞患者颅外颈动脉MSCTA和超声对照

目的：探讨MSCTA和超声在脑梗塞患者颈动脉斑块检出、定性及狭窄程度判定的价值及两种检查方法间的一致性。方法：对41例脑梗塞病例行MSCTA及超声检查，其中4例同时行DSA检查。分别观察斑块有无、性质及血管狭窄程度，并采用一致性检验,观察两种方法的一致性。结果：68.85%（28/41）、82.93%（34/41）的患者发现有颅外颈动脉、颈动脉斑块。MSCTA、超声分别发现了共76处、69处颅外颈动脉斑块；两种检查方法共同判断的60处斑块的性质判定的一致性为75%（45/60），Kappa值为0.5915。两种检查方法对颅外颈动脉狭窄率判断一致性为78.26%。Kappa值为0.6882。对DSA证实的3处颅外颈动脉闭塞，MSCTA均做出了正确的诊断，超声正确判断1例，另两例分别误判为中、重度狭窄。结论：颈动脉粥样硬化和脑梗塞的关系密切。MSCTA、超声在斑块的性质及狭窄程度的判定上体现了良好的一致性，MSCTA可能检出更多的颈动脉斑块。对颈动脉血管闭塞的判断上，MSCTA较超声更为准确。

Correlative study of MSCT and ultrasonography of extracranial carotid artery in cerebral infarction

Objective: To assess the value of MSCTA and US for finding carotid artery atherosclerosis plaque,detecting plaque components and estimating the grade of carotid stenosis in patients with cerebral infarction and to discuss the correlation of the two method results. Methods: In 41 patients with cerebral infarction MSCTA and US were performed, 4/41 also had DSA examination. Location and characteristic of plaques, the grade of vessel stenosis were discerned. Coherence statistical method were used to find agreement of the two methods. Results: 68.85%(28/41), 82.93%(34/41) patients were found extracranial carotid, carotid atherosclerotic plaque; MSCTA and US separately detected 76 and 69 plaques; the agreement in detected 60 plaques components which two methods all found was 75%(45/60), the value of Kappa was 0.5915; the overall agreement of carotid stenosis grade obtained by two methods was 78.26%. The value of Kappa was 0.6882. Compared with DSA, 3 carotid occlusions were diagnosed correctly by CTA, but only 1 diagnosed correctly by US, other 2 underestimated as moderate and severe grade stenosis respectively. Conclusions: A close relation existed between carotid atherosclerotic plaque and brain infarction. There were fine agreement of MSCTA and US in detecting plaques components and estimating stenotic grade. MSCTA maybe found more plaques than US and was a more reliable method in diagnosis of carotid occlusion than US.