CT血管成像与血管彩色多普勒超声检查对急性脑梗死患者颈动脉颅外段病变诊断价值比较

Comparison of diagnostic value of CT angiography and vascular ultrasound examination of extracranial carotid arteries in patients with acute cerebral infarction

目的：比较256层螺旋头颈部CT血管成像（ CTA）与颈部血管彩色多普勒超声（彩超）检查对急性脑梗死患者颈动脉颅外段病变诊断的价值。方法回顾性分析258例急性脑梗死患者CTA及颈部血管彩超检查结果，分析二者对颈动脉颅外段血管狭窄诊断的敏感性和特异性，以及对斑块检出率的差异。结果 CTA与颈部血管彩超诊断颈动脉颅外段狭窄符合率为73．5％（1138/1548），对轻、中度狭窄诊断有较低程度的一致性（κ值分别为0．01、0．05），对重度狭窄、闭塞诊断有较高程度的一致性（κ值分别为0．34、0．47）。 CTA对颈内动脉和颈外动脉中斑块检出率[11．3％（175/1548）比1．4％（29/1548）]明显优于颈部血管彩超[3．2％（50/1548）比0．3％（4/1548）]，差异有统计学意义（χ^2＝74．89，P＜0．01；χ^2＝19．14，P＜0．01）。结论 CTA在诊断急性脑梗死患者颈动脉颅外段血管狭窄及斑块方面明显优于颈部血管彩超。

Objective To compare the diagnostic value of 256-slice CT angiography （ CTA ） and neck vascular ultrasound examination of the extracranial carotid artery disease in patients with acute cerebral infarction . Methods The test results of 256-slice CTA and neck vascular ultrasound examination of 258 cases of acute cere-bral infarction were retrospectively analyzed .Results 256-slice CT angiography and neck vascular ultrasound in the diagnosis of carotid artery stenosis of extracranial coincidence rate was 73.5%（1 138/1 548）;mild to moder-ate stenosis diagnosis had a lower degree of consistency （κvalues were 0.01, 0.05）;severe stenosis or occlusion diagnosis had a relatively high consistency （κvalue 0.34, 0.47）.Detection of plaque with 256-slice CTA of the internal carotid artery and external carotid artery was much better than that with neck vascular ultrasound （175/50,χ^2=74.89,P〈0.01;29/4,χ^2=19.14,P〈0.01）.Conclusion 256-sliceCTAinthediagnosisofextracranial carotid artery stenosis and plaque in patients with acute cerebral infarction is obviously superior to neck vascular color Doppler ultrasound .