64排螺旋CT血管成像在诊断后循环缺血性卒中的应用

Application of subtraction CTA in the diagnosis of posterior circulation ischemic stroke

目的探讨减影64排螺旋CT血管成像(CTA)在诊断后循环缺血性卒中的应用。方法对43例后循环缺血患者行头颈部CTA检查后,分别行减影CTA法重建与常规CTA法重建。所有患者行数字减影血管造影(DSA)检查。结果以DSA为金标准,43例减影CTA重建,较常规CTA重建诊断椎-基底动脉狭窄的平均所需时间短,减影法CTA可缩短多平面重建(MPR)、最大密度投影(MIP)及容积重建(VR)的重建时间,差异有统计学意义(P<0.01)。尤其在枕骨大孔以下层面的重建上,时间和效果都存在优势。常规法CTA和减影法CTA椎-基底动脉狭窄诊断对比,常规CTA诊断后循环缺血特异性99%,总体敏感性99%,总体准确性88%。对枕大孔以上诊断敏感性、特异性都是100%,对枕骨大孔以下后循环狭窄的敏感性89%,准确性为86%;减影CTA诊断枕骨大孔以下后循环系统血管狭窄病变有优势。诊断枕骨大孔以下颈动脉狭窄病变的敏感性和准确性较高,敏感性92%,准确性91%。减影CTA总体敏感性100%,总体准确性88%;常规CTA与减影CTA结合共同评估后循环血管狭窄的敏感性、特异性及准确性均为100%。结论减影法CTA对引起后循环缺血性卒中的椎-基底动脉狭窄的检查诊断具有重要意义。

] Objective To explore subtraction CTA in the diagnosis of posterior circulation ischemic stroke. Methods Forty-three patients with posterior circulation ischemia after head and neck CTA examination, respectively do subtraction CTA reconstruction method CTA reconstruction with conventional method. All patients do digital sub- traction angiography （DSA） inspection. Results With DSA as the gold standard, 43 cases of subtraction CTA recon- struction, more routine CTA reconstruction in the diagnosis of vertebral-basilar artery stenosis of the average time needed for short, CTA subtraction method can shorten the reconstruction of the MPR, MIP and VR time, and there was significant statistical difference （P〈0.01）. Especially on the reconstruction of the foramen magnum level below, time and effect had advantages. Routine CTA and subtraction CTA vertebral-basilar artery stenosis diagnosis contrast, routine CTA in the diagnosis of PCI specificity 99%, overall sensitivity was 99%, the overall accuracy of 88%. For great occipital foramen above the diagnostic sensitivity and specificity were 100%, below the foramen magnum poste- rior circulation stenosis of the sensitivity of 89%, the accuracy vgas 86%; Subtraction CTA in the diagnosis of foramen magnum circulation system after the following vascular stenosis disease had an advantage. Diagnosis of foramen mag- num following carotid stenosis lesions, the sensitivity of the lesions and the accuracy was higher, sensitivity 92%, 91% accuracy. Subtraction CTA overall sensitivity was 100%, the overall accuracy of 88%; routine CTA and subtraction angiography were combined to assess the posterior circulation vascular stenosis, the sensitivity, specificity and accura- cy of vascular stenosis was 100%. Conclusion CTA subtraction method as to the cause of posterior circulation is- chemic stroke inspection diagnosis of vertebral-basilar artery stenosis is of great significance.