MR和CT血管造影在诊断颈动脉狭窄及内膜切除术后随访中的价值

The application of MR and CT angiography in the evaluation of carotid artery stenosis and follow up of carotid endarterectomy

目的 探讨磁共振血管造影 (MRA)、CT血管造影 (CTA)在诊断颈动脉狭窄及内膜切除术后随访中的价值。方法 11例 2 2支颈动脉行MRA、CTA、CT仿真内窥镜 (CTVE)、多普勒超声 (DUS)检查。 12支结果与DSA对照。 3支颈动脉重度狭窄者行内膜切除术。MRA采用二维、三维时间飞越法。CTA经最大强度投影 (MIP)及遮盖表面显示法 (SSD)三维重建。应用导航功能行CTVE成像。结果 颈动脉轻度狭窄 8支 ,中度狭窄 3支 ,重度狭窄 5支 ,闭塞 1支 ,5支正常。 12支颈动脉与DSA对照 :CTA评估血管狭窄与DSA相符者 11支 ,MRA与DSA相符者 9支 ,DUS与DSA相符者 7支。CTA、CTVE显示斑块、附壁血栓 6支 ,3支手术证实。术后MRA示狭窄解除 ,CTA示斑块消失。结论MRA、DUS可用于颈动脉狭窄的筛选及术后随访。CTA评估血管狭窄程度与DSA、手术比较有较好的一致性 ,并能直接显示钙化斑块。

Objective To estimate the accuracy of MR angiography(MRA) and CT angiography(CTA) in the evaluation of the carotid artery stenosis. Methods Eleven patients were studied with MRA and CTA. The results were compared with DSA, CT virtual endoscopy (CTVE), and Doppler ultrasound (DUS). MRA was performed with 2D and 3D TOF sequences. CTA was postprocessed using MIP and SSD. CTVE was performed using navigator function . Three patients with severe stenosis received carotid endarterectomy. Results There was a total of 22 carotid arteries studied, with 8 mild, 3 moderate, 5 severe stenosis, 1 occlusion, and 5 normal. Agreement on stenosis between CTA and DSA was found in 11 of 12 carotid arteries. Agreement on stenosis between MRA and DSA was found in 9. Plaques were delineated in CTA, CTVE, and confirmed by pathology in 3 cases. Postoperative MRA and CTA proved the release of stenosis. Conclusion MRA and DUS can be used as a screening technique to evaluate carotid artery stenosis and as a convenient follow up modality for post endarterectomy. CTA has a high degree of accuracy for the assessment of carotid artery stenosis compared with DSA, and it could provide information on calcified plaque.