能谱CT成像与颈部血管超声评价颈动脉狭窄的对比研究

目的 探讨能谱CT成像与颈部血管超声在颈动脉狭窄评价中的应用价值。方法 纳入2016年6月—2021年6月河南省驻马店市中心医院数字减影血管造影（DSA）确诊为颈动脉狭窄的缺血性脑卒中（IS）患者289例,其中男159例、女130例,年龄43~82（61.7±8.0）岁。患者均行能谱CT和颈部血管超声检查,以DSA诊断结果为金标准,比较能谱CT及颈部血管超声诊断颈动脉狭窄程度的一致性;比较2种检查方法对不同程度颈动脉狭窄的诊断效能;比较2种检查方法对颈总动脉易损斑块的检出率。结果 以DSA诊断结果为金标准,能谱CT及超声检测颈动脉狭窄程度Kappa值分别为0.844、0.882,均具有较好的一致性;除了颈部血管超声诊断颈动脉轻度狭窄的灵敏度较低、能谱CT诊断颈动脉轻度狭窄的阳性预测值较低外,能谱CT及颈部血管超声对不同程度颈动脉狭窄的诊断均具有较高的准确率、灵敏度、特异度、阳性预测值及阴性预测值。在颈总动脉上,DSA共检出易损斑块1 672个;颈部血管超声检出876个,其中软斑块384个、表面不规则斑块80个、溃疡斑412个,易损斑块检出率为52.39%（876/1 672）;能谱CT检出367个,均为软斑块,易损斑块检出率为21.95%（367/1 672）。血管超声易损斑块检出率高于能谱CT,差异有统计学意义（χ²=509.00,P<0.001）。结论 能谱CT成像与颈部血管超声均能准确判断颈动脉狭窄程度,超声可能在颈总动脉易损斑块评估中更具价值,临床应用时可将两种方式联合使用。

Comparative study on the evaluation of energy-spectrum CT imaging and cervical vascular ultrasound for carotid stenosis

Objective This study aimed to compare the evaluation of energy-spectrum CT imaging with that of cervical vascular ultrasound for carotid stenosis.Methods A total of 289 patients with ischemic stroke (IS) of carotid stenosis confirmed by digital subtraction angiography (DSA) were included in Zhumadian Central Hospital. The patients, who were enrolled between June 2016 and June 2021, comprised 159 males and 130 females. Their average age was 43-82 (61.7±8.0) years. All underwent examination of energy-spectrum CT and cervical vascular ultrasound. Taking DSA results as the golden standard, we compared the consistency between energy-spectrum CT and cervical vascular ultrasound in diagnosing carotid-stenosis severity, the diagnostic efficiency of the two methods for different severities of carotid stenosis, and the detection rates of vulnerable plaques in the common carotid artery.Results The Kappa values of energy-spectrum CT and ultrasound for detecting the severity of carotid stenosis were 0.844 and 0.882, respectively, with good consistency. Except for the low sensitivity of cervical vascular ultrasound and low positive predictive value of energy-spectrum CT in diagnosing mild carotid stenosis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of energy-spectrum CT and cervical vascular ultrasound were high for diagnosing different severities of carotid stenosis. DSA showed 1 672 vulnerable plaques in the common carotid artery. Cervical vascular ultrasound showed 876 vulnerable plaques in the common carotid artery, including 384 soft plaques, 80 plaques with irregular surface, and 412 ulcer plaques. The detection rate of vulnerable plaques was 52.39% (876/1 672). The energy-spectrum CT showed 367 vulnerable plaques in the common carotid artery, all of which were soft plaques. The detection rate of vulnerable plaques was 21.95% (367/1 672). The detection rate of vulnerable plaques by vascular ultrasound was higher than that by energy-spectrum CT (χ²=509.00, P<0.001). Conclusion Energy-spectrum CT imaging and cervical vascular ultrasound can accurately determine the severity of carotid stenosis. Ultrasound may be more valuable in assessing vulnerable plaque in the common carotid artery. The two methods can be combined in clinical application.