CTA及TCD对症状性颅内动脉狭窄的诊断价值

The Diagnostic Value of CTA and TCD on Symptomatic Intracranial Artery Stenosis

目的:探讨CT血管造影术(CTA)及经颅多普勒超声(TCD)对症状性颅内动脉狭窄(ICASS)的诊断价值。方法:72例ICASS患者作为观察组,选取同期79例健康体检者作为对照组,观察组患者行数字减影血管造影术(DSA)、CTA及TCD检测,对照组仅行TCD检测;以DSA检测结果为金标准,比较CTA与TCD对观察组患者ICASS的诊断符合率及对血管狭窄程度的判断符合率、比较CTA及TCD对颈内动脉或椎基底动脉系统血管狭窄情况的诊断符合率;比较两组对象TCD检测时血流高速峰值(Vm)和搏动指数(PI)。结果:观察组共纳入的504条血管,DSA共检出142条狭窄血管,CTA共检出131条狭窄血管、TCD共检出103条狭窄血管,以DSA为金标准,CTA诊断符合率明显高于TCD,差异具有统计学意义(χ~2=4.363,P=0.037);CTA、TCD对ICASS血管狭窄程度的判断符合率比较,差异无统计学意义(χ~2=4.989,P=0.173);对于颈内动脉系统狭窄血管的检测,TCD诊断符合率高于CTA,差异具有统计学意义(χ~2=4.807,P=0.028);对于椎基底动脉系统狭窄血管检测,CTA诊断符合率明显高于TCD,差异具有统计学意义(χ~2=44.3,P<0.001);观察组患者Vm、PI指数明显低于对照组,差异均具有统计学意义(P<0.05)。结论:CTA及TCD均对ICASS患者具有临床诊断价值,二者可互为补充,提高诊断效率。

Objective： To investigate the diagnostic value of TCD and CTA in patients with ICASS. Methods： Analyzing the clinical data of 72 patients with ICASS as observation group, 79 healthy peo- ple as control group. Observation group went through DSA, CTA and TCD test, while control group went through TCD test. Taking DSA test result as gold standard, comparing diagnose accordance rate of CTA and TCD on observation group, diagnostic coincidence rate of stenosis degree ; comparing diag- nose accordance rate of CTA and TCD on internal carotid or vertebrobasilar system stenosis; comparing Vm and PI of both groups during TCD test. Results： This study included 72 ICASS patients （504 vessels） , DSA discovered 142 stenotic arteries, while CTA discovered 131 and TCD, 103. Taking DSA as gold standard, diagnostic accordance rate of CTA was obviously higher than that of TCD, the differ- ences were statistically significant （χ2 = 4. 363, P = 0. 037 ） ; comparing detection value of ICASS by CTA and TCD, the difference was not statistically significant （χ2 = 4. 989 ,P = 0. 173 ） ;for the detection of vertebrobasilar system artery stenosis, the positive rate of TCD was significantly higher than that of CTA, the difference was statistically significant （χ2 = 4. 807, P = 0. 028 ） ; for the detection of verte- bral basilar artery stenosis, the positive rate of CTA was significantly higher than that of TCD, the difference was statistically significant （χ2 =44.3 ,P 〈 0. 001 ） ;Vm, PI index was significantly lower in observation group than the control group, the difference was statistically significant（ P 〈 0. 05 ）. Conelusions： CTA and TCD have diagnostic value in patients with ICASS, the two could be complimentary and improve diagnostic value.