周围动脉闭塞性疾病的双能CT血管造影评价

Evaluation of Peripheral Arterial Occlusive Disease by Dual-energy CT Angiography

目的:探讨双能CT(DECT)血管造影对周围动脉闭塞性疾病(PAOD)的诊断价值。方法:45例已确诊断或怀疑PAOD患者行双能CT血管造影检查,由两名放射科医生对下肢动脉狭窄程度和范围进行评估,以常规数字减影血管造影(DSA)为金标准,评价DECT血管造影诊断下肢动脉狭窄程度的准确性。结果:45例PAOD患者总计285段动脉同时接受DECT血管造影及DSA评估,90.2%(257/285)动脉节段在DECT血管造影图像质量为优,DSA显示41.1%(117/285)动脉节段狭窄程度≥50%。包括钙斑时DECT血管造影诊断下肢动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为80.7%、91.5%、86.8%,87.2%和87.1%。去除钙斑后DECT血管造影诊断下肢动脉管腔狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为84.2%、96.3%、94.1%,89.8%和91.4%。结论:DECT血管造影能够去除骨骼及下肢动脉管壁钙化斑块,有助于钙化斑块附着处动脉管腔狭窄程度的评估,可作为PAOD介入治疗前的常规筛查。

Purpose： To evaluate the accuracy and feasibility of dual-energy computed tomography （DECT） angiography in diagnosing peripheral arterial occlusive disease （PAOD）. Methods： Forty-five patients with known or suspected PAOD underwent DECT angiography. Findings were evaluated by two radiologists in a blinded way. The accuracy of DECT angiography in the diagnosis of FAOD was evaluated by using the result of digital subtraction angiography （DSA） as the golden standard. Results： In 45 patients, 285 vascular segments were evaluated by both DECT angiography and DSA. Image quality of DECT angiography was scored as excellent in 257/285（90.2%） segments. Significant stenosis of the peripheral artery was observed on DSA in 117/285（41.1%） segments. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DECT angiography without calcified plaque removal were 80.7%, 91.5%, 86.8%, 87.2% and 87.1%; whereas these values of DECT angiography with calcified plaque removal by the dual-energy bone and hard plaque removal technique were 84.2%, 96.3%, 94.1%, 89.8% and 91.4%, respectively. Conclusion： DECT with bone and calcified plaque removal is quite valuable method for diagnosing PAOD, especially for the evaluation of calcified segments. It can be used as a screening exam before DSA in routine clinical practice.