Fontaine Ⅱ期及以上分期下肢动脉硬化闭塞症的128层CTA技术探讨

TECHNIQUE OF 128 SLICE SPIRAL CT ANGIOGRAPHY IN ATHEROSCLEROSIS OCCLUSION OF LOWER EXTREMITY AT FONTAINE'S Ⅱ AND THE ABOVE STAGES

目的分析128层CT的不同扫描技术在下肢CT血管造影技术(CTA)对下肢动脉硬化闭塞症(PAOD)FontaineⅡa期及以上分期中的应用价值,选出最具优势的检查手段。方法回顾性分析FontaineⅡa期及以上分期的PAOD患者共43例(患肢50侧)的下肢动脉血管CTA图像,并与数字减影血管造影(DSA)检查结果进行统计学分析,计算CTA对动脉狭窄>50%病例的明确诊断。并按不同的CTA检查技术方法进行分组,分析其重组血管清晰度及显示血管节段数,进行组间结果对照分析。结果以下肢动脉管腔径狭窄50%为阈值,CTA检查的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为100%、97.31%、98.10%、96.51%、100%。结论对于FontaineⅡa期及以上分期PAOD的血管狭窄度的判断,CTA具有高度敏感性及准确性,可为PAOD的临床治疗提供准确可靠的指导。对于FontaineⅡa期及以下分期的PAOD采用腘动脉团注触发技术扫描即可获得满意图像;而对于FontaineⅡb及以上分期的PAOD血管狭窄度的判断,采用经验值扫描可以获得更满意图像。

Objective： To investigate the clinical value of different technique of 128 slice spiral CT angiography （CTA） in atherosclerosis occlusion of lower extremity at Fontaine＇s II and the above stages, Methods： 43 patients （50 affected extremity） with PAOD were enrolled consecutively in the study. Overall 50 affected extremity were adequately visualized with both 128-SCTA and DSA and were included in the statistical analysis. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA arterial stenosis 〉 50% were calculated. According to the different CTA examination technology, the results were divided into two groups, and analyzed and compared between them. Results： All affected extremity were adequately visualized with both 128-SCTA and DSA and were included in the statistical analysis. The sensitivity, specificity, accuracy ,positive predictive and negative predictive value of 128-SCTA in patients with stenosis 〉50% were 100%, 97.31%, 98.10%, 96.51% and 100% respectively. Conclusion： The study demonstrates excellent diagnostic accuracy of 128-SCTA in the detection of hemodynarnically significant disease of the lower extremities. For PAOD of Fontaine＇s IIa and the below classification, more satisfactory images can be obtained by using the popliteal artery bolus technique, while for PAOD of Fontaine＇s IIb and the above classification, more satisfactory images can be obtained by using the experience value scan.