64排螺旋CT血管造影诊断椎动脉起始段狭窄的价值

目的：通过与数字减影（DSA）对比，评价64排螺旋CT血管造影（CTA）诊断椎动脉起始段狭窄的价值。方法：2005年12月～2008年4月同时行DSA与CTA检查的临床脑血管病患者398例。采用NASCET标准，由两名高年资医师分别对398例共796条椎动脉进行CTA与DSA测量，以远心端椎动脉作参考，用敏感性、特异性、阳性预测值和阴性预测值评价CTA诊断椎动脉狭窄的价值，用卡方检验评价CTA与DSA检测椎动脉斑块的差异有否显著意义。结果：①以DSA为金标准，CTA诊断椎动脉起始段狭窄的阴性预测值为100%。敏感性、特异性、阳性预测值分别为100%，97.6%，93.9%。②以DSA为金标准，CTA诊断椎动脉起始段≥50%狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为100%，97.3%，82.1%,100%。③以DSA为金标准，CTA诊断＜50%向心性狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为92.0%，100%，100%，99.5%；CTA诊断＜50%偏心性狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为78.3%，98.1%，79.4%，97.9%。阳性预测值较低与DSA假阴性有关。④CTA检测椎动脉斑块较DSA有显著差异，χ2=27.26，P<0.05。结论：CTA诊断椎动脉起始段狭窄有很高的敏感性、特异性和阴性预测值，对偏心性狭窄和斑块的评估能力优于DSA，是诊断椎动脉起始段狭窄的可靠手段。

The application of 64 multidetector CT angiography in the evaluation of proximal vertebral artery stenosis

Objective:To evaluate the diagnostic value of 64 multidetector CT angiography (CTA) for proximal vertebral artery stenosis compared with digital subtraction angiography (DSA). Methods: All patients with interpretable CTA and DSA of the proximal vertebral arteries from Dec. 2005 to Apr. 2008 were included in this study. This yieled a total of 796 vessels. Two senior neuroradiologists graded the CTA and DSA images referring to the distal vertebral artery, according to the North American Symptomatic Carotid En...