64层螺旋CT数字减影后造影对头颈部血管狭窄性疾病诊断价值

Digital Subtraction 64-Slice Spiral CT Angiography in Diagnosis of Arterial Stenosis in Intracranial and Neck Vessels

目的探讨数字减影后CT血管造影(DSCTA)在头颈部血管狭窄性疾病诊断中的价值及不足。资料与方法回顾性分析189例临床怀疑头颈部血管狭窄性疾病患者的临床及影像学资料。189例患者均接受64-MSC-TA检查,每例患者采用相同的技术参数先后进行平扫及增强扫描,原始数据传入工作站后进行自动减影,对减影后的数据进行三维容积再现(3D-VR)及多平面重组(MPR)、最大密度投影(MIP)等后处理,并对狭窄血管进行评估、诊断。其中60例患者在2周内接受了数字减影血管造影(DSA)检查,以其作为金标准,探讨DSCTA在头颈部血管狭窄性疾病中的诊断价值。结果 189例患者经MSCTA检查后128例示头颈部血管狭窄,其中60例经DSA检查对比,得出MSCTA诊断血管狭窄的敏感性96.5%、特异性99.3%、准确性98.6%、阳性预测值95.8%、阴性预测值99.8%。结论 DSCTA显示头颈部血管的图像优良,操作省时、方便,具有去除骨质、凸显血管的优点;尤其在头颈部血管狭窄性疾病诊断方面,可以替代DSA成为筛查、诊断及术后随访疾病的重要方法。

Objective To evaluate the value of digital subtraction CT angiography（DSCTA）in diagnosis of arterial stenosis in intracranial and neck vessels.Materials and Methods Retrospective analysis of clinical and imaging data of 189 patients with suspected head and neck vascular disease was performed.189 patients received 64-MSCTA examination,each patient used the same technical parameters for plain and enhanced CT scan,the original imaging data were taken into the workstation automatically for the subtraction of the data,three-dimensional volume reconstruction（3D-VR） and multiplanar reconstruction（MPR）,maximum intensity projection（MIP） and other post-processing were adopted.60 patients received DSA in two weeks as the gold standard to evaluate vascular stenosis.Results 189 patients examed by head and neck MSCTA showed 128 patients with vascular stenosis,60 patients with DSA.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MSCTA in diagnosis of vascular stenosis were 96.5%,99.3%,98.6%,95.8%,99.8% respectively.Conclusion DSCTA has excellent quality images of head and neck vessels,which has advantages of the operation time-saving,convenient,removal of bone.DSCTA can replace DSA as screening,diagnosis and postoperative follow up in head and neck vascular disease.