基于CTA和眼底成像观察颈内动脉狭窄程度与视网膜血管管径的关系

CTA and fundus imaging in observation of relationship between internal carotid artery stenosis and retinal vascular calibers

目的分析颈内动脉(ICA)狭窄程度与同侧视网膜血管管径的关系,探讨通过观察视网膜血管管径改变评估ICA狭窄的准确性及可行性。方法基于CTA和眼底成像技术,分析243例患者单侧ICA狭窄程度和同侧视网膜血管管径资料,根据ICA最大狭窄率(Rmax)将患者分为无狭窄、轻度狭窄、中度狭窄和重度狭窄共4组,分析视网膜血管管径的组间差异及其与ICA狭窄程度的相关性。结果中、重度狭窄组的视网膜中央静脉管径(CRVE)较无狭窄和轻度狭窄组明显增宽(P均<0.05),4组间视网膜中央动脉管径(CRAE)和动静脉管径比值(AVR)差异无统计学意义(P均>0.05)。Rmax与同侧CRVE呈正相关(r=0.27,P<0.01),与AVR呈负相关(r=-0.16,P<0.05),与CRAE无相关性(P>0.05)。CRVE是同侧Rmax的影响因素(B=0.243,P<0.01),但模型的调整R2较小(0.173)。以229.5μm为最佳临界值,CRVE诊断ICA中重度狭窄的ROC曲线下面积为0.619,敏感度和特异度为80.3%、40.1%。结论 CRVE对ICA狭窄程度的评估与预测具有一定价值。

Objective To analyze the relationship between internal carotid artery （ICA） stenosis and ipsilateral retinal vascular calibers, and to investigate the feasibility and accuracy of changes of retinal vascular calibers for assessment of ICA stenosis. Methods Unilateral ICA and ipsilateral retinal vascular of 243 patients were enrolled based on CTA and fundus imaging. Patients were divided into 4 groups according to the highest ICA stenosis rate （Rmax）, i.e. no stenosis group, mild stenosis group, moderate stenosis group and severe stenosis group. The differences of retinal vascular calibers among four groups and correlation between retinal vascular calibers and ICA stenosis were analyzed. Results The average central retinal vein equivalents （CRVE） in moderate ICA stenosis group and severe stenosis group were significantly wider than those in the other two groups （all P 〈 0.05）. There was no statistical significance of central retinal artery equivalent （CRAE） nor retinal arteriolar-to-venular ratio （AVR） among groups （both P 〉 0.05）. Rmax was positively correlated with CRVE （r=0.27, P 〈 0.01） and negatively correlated with AVR （r=-0.16, P 〈 0.05）, whereas Rmax had no correlation with CRAE （P 〉 0.05）. CRVE was the impact factor of ipsilateral Rmax（B=0.243, P 〈 0.01）, but the adjusted R2 of the model was weak （0.173）. Area under the ROC curve of CRVE was 0.619 in assessing ICA moderate and severe stenosis, and taking threshold as 229.5 μm, the sensitivity and specificity was 80.3% and 40.1%, respectively. Conclusion CRVE can assess and predict ICA stenosis to some extent, but the diagnosis efficacy is limited.