CT血管造影对椎动脉粥样硬化性病变的诊断价值

目的：探讨CT血管造影（ CTA）诊断椎动脉粥样硬化性病变的临床价值。方法对87例临床拟诊为后循环缺血发作的患者进行16层螺旋CTA检查，其中51例于CTA检查前后1周内进行了数字减影血管造影（ DSA ）检查，53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，测量颅外段椎动脉狭窄程度，统计动脉粥样硬化斑块，并分别与DSA和CFDS结果比较。结果CTA与DSA对颅外段椎动脉狭窄程度分级判断的一致性为92．2％（Kappa＝0．89，P＜0．01），CTA对颅外段椎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，在轻度狭窄为87．50％、95．24％、87．50％、95．24％；中度狭窄为95．65％、96．67％、91．67％、98．31％；重度狭窄为100％、98．81％、93．75％、100％；闭塞为100％、100％、100％、100％。 CTA在颅外段椎动脉斑块检出率高于CFDS（P＜0．05）。结论 CTA对椎动脉狭窄的诊断准确性较高，而且能确切评价粥样硬化斑块，可作为椎动脉粥样硬化性病变筛选的常规方法。

Clinical Value of CT Angiography in Diagnosis of Vertebral Artery Atherosclerosis

Objective To assess the clinical value of CT angiography （ CTA） in the diagnosis of vertebral artery atherosclerosis .Methods Sixteen-section spiral CTA was performed on 87 patients with posterior circulation ischemia of cerebrum.Among them,51 patients underwent digital subtraction angiography （DSA） examinations and 53 also underwent color Doppler ultrasound （ CFDS） one week before and after CTA was performed .The three-dimensional reconstruction technology was applied to obtaining the axial images by CTA .The degrees of vascular stenosis and vertebral atherosclerosis plaque were detected ,which were compared with those detected by DSA and CFDS .Results The consistent rate of CTA and DSA in detecting stenosis of extracranial vertebral artery was 92.2%（Kappa=0.89,P〈0.01）.The sensitivity, specificity,positive and negative predictive value were 87.50%,95.24%,87.50% and 95.24% for mild stenosis diagnosed by CTA;95 .65%, 96 .67%, 91 .67% and 98 .31% for moderate stenosis diagnosed by CTA;100%, 98 .81%,93.75%and 100%for severe stenosis diagnosed by CTA;And 100%,100%,100%and 100%for occlusion diagnosed by CTA ,respectively .The detection rate of CTA in diagnosing stenosis of extracranial vertebral artery was significantly higher than that of CFDS （ P〈0 .05 ） .Conclusion CTA has a higher accuracy in the diagnosis of vertebral stenosis,and can be used to evaluate atherosclerotic plaque ,which deserves the routine method for a screening for vertebral atherosclerotic disease .