256层螺旋CT颈动脉血管成像在缺血性脑血管病诊断中的应用

Evaluation on appliable value of 256 slice spiral CT angiography of carotid for diagnosing ischemic cerebrovascular disease

目的应用256层螺旋CT探讨颈动脉血管成像(CTA)对缺血性脑血管病的应用价值。方法对100例脑缺血发作(TIA)和100例脑梗死患者临床资料进行回顾性分析,所有患者行颈部CTA检查,图像结合容积重组(VR)、多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)观察颈动脉斑块的分布及性质、准确测量狭窄程度,观察相应脑内动脉形态学变化及侧枝循环形成情况。结果 100例TIA患者中,存在颈动脉斑块72例(72%),其中非钙化斑块比率23%(30/128),检出血管轻中度狭窄占85%(68/80)、重度狭窄和闭塞占15%(12/80均为单侧);100例脑梗死患者中,存在颈动脉斑块94例(94%),其中非钙化斑块比率40%(70/174),检出血管轻中度狭窄占72%(98/136)、重度狭窄及闭塞占28%(38/136、双侧3例);两组比较脑梗死组斑块检出率、非钙化斑块比率及颈动脉重度狭窄和闭塞的发生率明显增加(P<0.05)。结论 TIA和脑梗死患者颈动脉粥样硬化程度存在显著性差异,血管狭窄程度及非钙化斑块与其密切相关;256层CTA能准确判断斑块性质、狭窄程度及侧枝循环情况,对缺血性脑血管病预防、治疗和预后判断具有重要价值。

Objeective To study the value of 256-slice spiral CT angiography of carotid（CTA） in diagnosing ischemic cerebrovascular disease. Methods The clinical data of 100 TIA （transient ischemia attrack）patients and 100 carotid atherosclerosis patients were retrospectively analyzed, all the cases were underwent multi-slice spiral CT angiography 0VISCTA）, and observation of the distribution and character of carotid artery atherosclerosis and the extent of stenosis and the morphological changes of intracerebral arteries and the formation of collateral circulation with transverse axial planar reconstruction, volume rendering （VR）, multiplanar reconstruction （MPR）, curved planar reconstruction （CPR） and maximun intensity projection （MIP）. Results In the 1130 cases of TIA, non-calcified atherosclerotic plaque was 23%（30/128）, mild to moderate stenosis 85%（68/80）, severe stenesis 15%（12/80, with single stenosis, at all）; in 100 cases of carotid atherosclerosis, non-calcified atherosclerotic plaque 40%（70/174）, mild to moderate stenosis 72%（98/136）,severe stenosis 28%（38/136, with double stenosis in 3 cases）; in the control group： the detection rate of plaque in the cerebral infarction group, the ratio of non-calcified atherosclerotie plaque and the incidence of the severe stenosis or occlusion of cariotid artery increased, the difference between two groups was statistically significant （P〈0.05）. Conclusion The difference of the extent of carotid atherosclerosis between TIA and carotid atherosclerosis groups is statistically significant, 256 CTA can diagnose the features of plaque, the extent of artery stenosis and the formation of collateral circulation correctly that have an important value in prevention, treatment and prognosis judge of ischemic cerebrovascular disease.