颈内动脉形态异常的对比影像诊断及其与缺血性脑血管病的关系

Morphological abnormalities of the internal carotid artery: comparative study on imaging diagnostic methods and relationship with ischemic cerebrovascular disease

目的 :比较CT血管造影(CTA)及彩色多普勒血流成像(CDFI)对颈内动脉形态异常的诊断价值,并探讨颈内动脉形态异常与缺血性脑血管病的关系。方法:选取2011年10月—2013年6月经临床诊断为缺血性脑血管病的患者126例,以DSA检查结果为金标准,采用Kappa检验,观察CTA、CDFI对颈内动脉形态异常分型的准确性。将所有患者分成脑梗组、TIA组及无症状组,采用方差分析,观察颈内动脉形态异常与缺血性脑血管病的关系。结果:76条颈动脉的CTA和CDFI分别与DSA比较,Kappa值=0.95和Kappa值=0.88(P<0.001),提示两者诊断符合率较高;252条颈动脉的CTA与CDFI比较,Kappa值=0.93(P<0.001),提示CTA与CDFI之间具有较高一致性。脑梗组、TIA组及无症状组的颈内动脉形态异常发生率有显著性差异(χ2=16.22,P=0.001),两两比较,脑梗组和TIA组的异常率均高于无症状组,差异有显著性意义,而脑梗组和TIA组异常率之间差异没有统计学意义。结论:CTA和CDFI均可用于评价颈内动脉形态异常。颈内动脉扭曲可能是缺血性脑血管病的危险因素之一。

Objective： To study the valve of CTA and color Doppler flow imaging（CDFI） in the diagnosis of the internal carotid artery（ICA） morphological abnormalities, and to explore the possible association with ischemic cerebrovascular disease.Methods： A total of 126 patients with ischemic cerebrovascular disease were enrolled in the study, and carotid abnormalities（CA） were classified by CTA and CDFI respectively. The Kappa-test was performed to check the results of the two examination methods with digital subtraction angiography（DSA） as the standard, and the accuracy of diagnosis and classification of CA was evaluated. One hundred and twenty-six cases were divided into three groups（cerebral infarction group, TIA group and asymptomatic group） according to patients＇ condition. Relationship between ICA abnormal morphology with three groups were analyzed by chi-square test individually. Results： Results of CTA and CDFI in 38 cases（76 carotid arteries） were compared with DSA diagnosis, respectively, with Kappa=0.95（P0.001） and Kappa=0.88（P0.001）, showing good consistency. And CTA in the diagnosis of ICA morphological abnormalities was slightly better than CDFI. Results of CTA and CDFI in 126 cases（252carotid arteries） were compared by Kappa test, with Kappa=0.93（P0.001）, representing high consistency of the two methods.There was significant difference in prevalence of patients with ischemic cerebrovascular disease between three groups（χ2=16.22,P =0.001）. The prevalence of distorted ICA of cerebral infarction group and TIA group was higher then asymptomatic group,but there was no significant difference between cerebral infarction group and TIA group. Conclusion： CTA has good agreement with CDFI in assessing ICA morphologic abnormalities. The existence of distorted ICA may be a risk factor for ischemic cerebrovascular disease.