多层螺旋CT血管造影在颈部动脉狭窄扩张和支架置入术中的临床应用

The Clinical Application of Multi-Slice CT Angiography in Dilatation and Stenting of Carotid, Subclavian and Vertebral Artery Stenosis

目的:探讨多层螺旋CT血管造影(MSCTA)诊断颈部动脉狭窄和粥样硬化斑块及其在血管腔内球囊扩张和支架置入术中的价值。材料和方法:对105例症状性颈部动脉硬化狭窄患者进行MSCTA检查,其中24例于MSCTA检查前后2周内进行了数字减影血管造影(DSA)检查,49例进行了彩色多普勒超声(CFDS)检查。MSCTA扫描横断面轴位图像应用三维重建技术作图像后处理,每段病变动脉的狭窄程度和成分比例由GEAW4.3工作站AVA软件自动测量。其中狭窄程度与DSA相比较,评价MSCTA自动测量血管诊断颈部动脉狭窄的准确性。粥样硬化斑块密度分析与CFDS相比较,评价MSCTA彩色编码技术分析成分比例的准确性。结果:以DSA为金标准,MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄的敏感性为96.4%,特异性为91.0%,阴性预测率为97.6%,阳性预测率为86.9%,准确性为93.1%。MSCTA检出的粥样硬化斑块图密度分析与CFDS的符合率为80.3%,其中诊断钙化斑块的敏感性为83.3%,特异性为98.2%,准确性为96.7%,阴性预测率为98.2%,阳性预测率为83.3%。结论:MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄以及诊断钙化斑块有较高的敏感性、特异性和准确性,有助于制订手术方案,选择介入材料及对术中病变部位栓子脱落危险性的评估。

Purpose： To discuss the diagnostic value of multi-slice CT angiography （MSCTA） in carotid stenosis and atherosclerosis plaques and the value in dilatation and stenting. Materials and Methods： 105 patients with symptomatic carotid stenosis were studied by MSCTA. 24 patients also underwent DSA within two weeks of MSCTA, and 49 patients underwent CFDS. The post-processing of image data including 3D reformation was performed after axial images were obtained. The degree of vascular stenosis and plaque density was analyzed by AVA software of GE AW 4.3 work station. The degree of stenosis was correlated with DSA to evaluate the accuracy of quantitative vascular measurement of MSCTA for carotid stenosis. The density analysis of atherosclerosis plaques was correlated with CFDS to evaluate the accuracy of Color Identification of MSCTA for classification of atherosclerosis plaques. Results： When DSA as golden standard, the sensitivity, specificity, negative and positive predictive value and accuracy to identify ≥70% stenosis with MSCTA were 96.4%, 91.0%, 97.6%, 86.9%, 93.1%, respectively. When CFDS as golden standard, the conformable rate of the density analysis with MSCTA was 80.3%, and the sensitivity, specificity, negative and positive predictive value and accuracy to identify calcium plaque with MSCTA were 83. 3%, 98.2%, 98.2%, 83.3%, 96.7%, respectively. Conclusions： MSCTA permits the visualization of significant carotid stenosis （ ≥70% ） and calcium plaque with high sensitivity, specificity and accuracy. It may help pre-procedure planning, interventional materials selecting and may help to evaluate the risk of shedding atheroma into distal circulation.