彩色多普勒超声与64层CT血管造影在巨细胞颞动脉炎诊断中的应用价值

目的探讨彩色多普勒超声与CT血管造影（CTA）检查在巨细胞动脉炎临床诊断中的应用价值。方法2006年10月至2008年11月在山东省医学影像学研究所风湿免疫科住院患者21例，经彩色多普勒超声诊断巨细胞颞动脉炎后，所有病例均进行颞浅动脉CT强化扫描检查并行颞浅动脉血管三维重建CTA。21例病例均进行颞动脉活检。结果彩色多普勒超声在所有21例病例中共检出病变血管32条，巨细胞动脉炎的超声形态学特征性改变为：二维超声图像上表现为血管壁回声减低，血管壁呈向心性增厚，血管腔内径变窄，病变血管呈节段性改变；在彩色多普勒血流显像检查时颞动脉血管腔周围有一特征性的低回声晕，血管腔狭窄，血管腔内血流信号呈周边充盈缺损样改变，当血管腔闭塞时血管腔内无血流信号显示；或者血管内膜呈不规则增厚，回声增强，血管腔不规则狭窄，类似于动脉硬化斑块形成。所有21例患者1次颞浅动脉血管CTA检查均可清晰成像，共检出病变血管30条，病变血管狭窄时，血管腔内影像显示对比剂浓度变淡，血管边缘处对比剂呈不规则充盈缺损改变，部分病变段血管腔内径呈特征性串珠样改变；血管闭塞时，正常血管走行区域对比剂显示中断、消失。21例颞动脉活检病例中阳性者占19例，64层螺旋强化CT血管成像检查诊断正确符合率为90．4％（19／21），彩色多普勒超声诊断与病理活检结果相符者19例，占所有病例的90．4％（19／21）。结论高分辨率彩色多普勒超声和64层螺旋强化CT血管成像在诊断巨细胞颞动脉炎中能够清楚地显示颞动脉及分支血管狭窄或闭塞，为临床诊断巨细胞颞动脉炎提供准确的诊断依据，并可用以替代传统的创伤性数字造影检查。在诊断功能上可替代病变血管组织病理活检，减少患者的痛苦，具有重要的临床价值和社会效益。

Evaluation of clinical application of color Doppler ultrasonography and 64 slice contrast computed tomographic angiography in the diagnosis of giant cell temporal arteritis

Objective To evaluate the clinical application of color Doppler ultrasonography and 64 slice contrast computed tomographic angigraphy（CTA） in the diagnosis giant cell temporal arteritis（ GCTA）. Methods The total of 21 cases who were suspected as giant cell temporal arteritis clinically were assessed by color Doppler ultrasonography and CTA. All of the cases were diagnosed as giant cell temporal arteritis （GCTA） by colour Doppler ultrasonography and CTA. The biopsy of the segmental temporal artery was performed in all patients. The results diagnosed by ultrasonographic and CTA imaging were compared statistically with the biopsy results of the temporal arteries. Results 19/21 patients were comfirmed with GCTA by biopsy, compared with the results of biopsy, the diagnostic accuracy of color Doppler nhrasonography and CTA were 90. 4% （ 19/21 ） and 90.4% （ 19/21 ）, respectively. The main sonographic features for diagnosing GCTA were the sign of a hypoechoic ＂halo＂ around the temporal artery lumin with the pathological vascular segmental stenosis in colour Doppler blood flow imaging. In all CTA examnitions, 30 pathological vessels （23 with stenosis, 7 oclusion） were detected, the characteristics of CTA for displaying the temporal arterial stenosis was the classic sign of ＂ string of beads ＂. Conclusions Color Doppler ultrasonography and CTA can clearly show the segmental pathological stenosis and occlusion of temporal artery orand are noninvasive tools for detecting temporal diseases ,which could be considered as a noninvasive diagnosis method to replace the traditional digital subtraction angiography in the diagnosis of GCTA.