椎-基底动脉穿颅底段血管狭窄的3种影像学检查分析

COMPARISON ON THREE IMAGING EXAMINATIONS IN SKULL BASAL VERTEBAL ARTERY STENOSIS

目的探讨64排螺旋CT血管造影(64-slice CT angiography,64-SCTA)、MR血管造影(magnetic resonance angiography,MRA)对椎-基底动脉穿颅底段血管狭窄程度及管壁斑块性质评估的临床应用价值。方法回顾性分析后循环缺血并同期行64-SCTA、MRA、数字减影血管造影(digital subtraction angiography,DSA)检查的50例患者图像。比较64-SCTA、MRA、DSA 3种检测法对评价椎-基底动脉穿颅底段血管狭窄程度构成比的能力;以DSA检查结果为"金标准",分别计算64-SCTA及MRA对椎-基底动脉穿颅底段血管狭窄程度诊断的灵敏度、特异度、准确率;测量椎-基底动脉穿颅底段管壁斑块的密度,比较64-SCTA、MRA及DSA发现椎-基底动脉穿颅底段管壁斑块及评估斑块性质的能力。结果 64-SCTA、MRA、DSA 3种检测法对评价椎-基底动脉穿颅底段血管狭窄程度构成比的差异无统计学意义;在评价椎-基底动脉穿颅底段狭窄程度方面,64-SCTA、MRA对V_4和V_5段敏感度、特异度和准确度较高,MRA对V_2和V_3段敏感度、特异度和准确度最低;64-SCTA、MRA及DSA发现椎-基底动脉穿颅底段血管斑块能力的差异有统计学意义。结论 64-SCTA、MRA对椎-基底动脉V_4和V_5段血管狭窄程度的评估有着较高的诊断价值;64-SCTA发现椎-基底动脉穿颅底段血管斑块和评估斑块性质能力优于DSA和MRA,64-SCTA对指导临床治疗具有重要意义。

Objective To evaluate the clinical application value of 64-slice CT angiography （64-SCTA）, magnetic resonance angiography （MRA） for the skull basal vertebral artery stenosis compared with digital subtraction angiography （DSA） ;To explore the volue of 64-SCTA, MRA and DSA in detecting the nature of plague of the skull basal segment of vertebral artery. Methods A total of 50 patients diagnosed posterior circulation ischemia underwent 64-SCTA, MRA and DSA in our hospital. Their images were retrospectively analyzed. The constituent ratio of 64-SCTA, MRA and DSA for the skull basal vertebral artery stenosis were calculated. The results of 64-SCTA, MRA and DSA were analyzed statistically. The accuracy, sensitivity and specificity were respectively calculated for 64-SCTA and MRA by the ＂gold standard＂ for DSA. The results of 64-SCTA and MRA were analyzed statistically. The density of plague of the skull basal segment of vertebral artery was detected. The results of 64-SCTA, MRA and DSA were analyzed respectively. Results There were significant difference among 64-SCTA, MRA and DSA in diagnosing the constituent ratio of the skull basal vertebral artery stenosis. 64-SCTA, MRA had higher accuracy, sensitivity and specificity in diagnosing the V4 -5 segment of vertebral artery stenosis. MRA had the lowest accuracy, sensitivity and specificity in diagnosing the V2-3 segment of vertebral artery stenosis, and the comparison between 64-SCTA, MRA and DSA in diagnosing plague nature of the skull basal vertebral artery showed significant difference. Conclusion 64-SCTA, MRA in evaluating the V4-5 segment of vertebral artery stenosis proved higher diagnostic value;64-SCTA in detecting plague nature of the skull basal vertebral artery has higher accuracy than DSA, especially in MRA, 64-SCTA has significance in guiding clinical treatment.