血管超声与64排CT血管造影诊断颈动脉狭窄的对比研究

Color Doppler ultrasound in the assessment of carotid artery stenosis: comparison with 64-MSCT angiography

目的：探讨血管超声与64排螺旋CT血管造影（MSCTA）在评价颈动脉狭窄中的价值。方法68例颅外段颈动脉狭窄患者于1周内分别行血管超声及CTA检查，共计272个节段，以DSA检查结果为金标准，对血管超声与CTA对颈动脉狭窄检出的情况进行比较分析。结果超声和CTA对颈动脉轻度狭窄（＜50%）、中度狭窄（50%～69%）、重度狭窄和完全闭塞≥70%的判断符合率分别为83.5%、80.6%、87.5%及79.7%、75.0%、83.3%，超声和CTA对不同程度颈动脉狭窄判断符合率之间无统计学差异（P＞0.05）。超声和CTA对共同检出的163条血管狭窄率计算值呈显著线性正相关（P＜0.01）。血管超声、CTA诊断颈动脉狭窄≥70%的准确度、敏感度、特异度分别为95.7%、87.5%、95.7%及91.4%、83.3%、94.7%，2种方法判断≥70%颈动脉狭窄的ROC曲线下面积分别为0.945、0.925，差异无统计学意义（P＞0.05）。结论血管超声与MSCTA在评估颈动脉血管狭窄程度上具有较好的一致性，能够取代有创性DSA诊断颈动脉的重度狭窄和完全闭塞。

Objective To assess the value of ultrasound（US） and 64-slice CT angiography （MSCTA） in the diagnosis of carotid artery stenosis. Methods Sixty-eight patients with extraeranial carotid stenosis including 272 segments were examined by ultrasound and CTA within one week, the results of DSA were used as a golden standard. The results of ultrasound and CTA were comparatively analyzed. Results The consistent rates in diagnosis on mild-stenosis（〈 50%）, moderate-stenosis（50%-69%）, severe-stenosis and complete occlusion（≥ 70%） by US and CTA was 83.5%, 80.6%, 87.5% and 79.7%, 75.0%, 83.3%, there were no significant difference （P〉 0.05）. US and CTA were correlated significantly on calculating the stenosis rate （r=0.833, P〈0.01）. For assessing ≥70% stenosis, ROC analysis showed that the diagnostic accuracy was no significantly difference on US and CTA, the AUC values measured by US and CTA were 0.945, 0.925（Z=0.828, P〉0.05）. Conclusions US has good agreement with MSCTA in assessing carotid artery stenosis, and may replace invasive DSA diagnosis of severe-stenosis and complete occlusion.