256iCT血管成像在下肢动脉硬化闭塞症中的应用价值

The Value of 256iCT Angiography in Lower Extremity Arteriosclerotic Occlusive Disease

目的:探讨256iCT双下肢血管成像在动脉硬化闭塞症中的临床应用价值。方法:对119例有临床症状的下肢动脉硬化闭塞症患者行256iCT双下肢动脉增强扫描,扫描范围从腹腔干水平到达足底,将薄层轴位原始图像传入EBW工作站,进行血管三维重建。75例患者在行CT扫描后的1～2周内行DSA检查,将256iCT血管图像与DSA图像进行对比分析。结果:在1575个动脉节段中,1505个节段在CTA与DSA均可以显示,以DSA为诊断标准,256iCTA诊断下肢动脉闭塞的的敏感性、特异性、准确性分别为100.0%、98.8%、99.7%;对于显示中度以上狭窄,256iCTA的敏感性、特异性、准确性分别为99.3%、97.8%、98.2%。256iCT血管成像在评估下肢动脉硬化闭塞症与DSA结果一致性非常好(k=0.945)。975处节段性病变中,905处管壁存在管壁粥样斑块,12处为附壁血栓。结论:256iCT下肢血管成像是下肢动脉硬化闭塞症的理想的影像学手段,对临床制定治疗方案有重要的指导价值。

Objective： To assess the clinical value of 256i CT angiography in the arteriosclerotic occlusive disease （ASO） of lower extremity. Methods： A total of 119 patients with symptomatic arteriosclerotic occlusive disease of lower extremity underwent 256i CT angiography. The scan ranged from the celiac to thenar artery. Original axial images were transferred to EBW workstation and 3D reconstruction images were performed. 75 patients underwent digital subtraction angiography （DSA） between 0 and 14 days after CT angiography. The manifestations of 256i CT angiography were compared with those of DSA. Results： Of 1575 segments of arteries, 1505 were displayed on both DSA and CTA. DSA images as the gold standard, the sensitivity, specificity and accuracy of 256i CTA were 100.0%, 98.8%, 99.7% in displaying the segments occluded and 99.3%, 97.8%, 98.2% in detecting the segments that had more than moderate stenosis. Therefore, there was excellent agreement between 256i CT angiographic and DSA findings in the assessment of ASO （k = 0.945）. Of 975 segments, 905 were found atherosclerotic plaques, 12 were simple mural thrombus. Conclusion： The diagnostic performance of 256i CT angiography is excellent in patients with clinical symptoms of the arteriosclerotic occlusive disease of lower extremity. The results can be used to effectively guide therapeutic decision making in these patients.