颈部血管超声血流显像、CTA在颈动脉重度狭窄患者术前诊断及术后随访中的应用

Application of Cervical Vascular Color Doppler Flow Imaging and CTA in Preoperative Diagnosis and Postoperative Follow-Up in Patients with Severe Carotid Stenosis

目的研究颈动脉重度狭窄患者术前诊断及术后随访使用颈部血管超声血流显像(CDFI)、CT血管造影(CTA)检查情况。方法选择我院2016年3月至2018年6月收治的颈动脉狭窄且需进行颈动脉内膜剥脱术患者102例,术后实施为期6月随访调查,术前及术后随访均实施数字减影血管造影(DSA)、CDFI、CAT检查,并以DSA检查结果为“金标准”,观察两种检查方式术前对颈动脉狭窄检出情况及诊断效能分析,并评估患者术前、术后随访血管狭窄情况。结果78例手术患者实施DSA检查重度狭窄患者58例(74.35%),CDFI检查重度狭窄患者52例(66.67%),CTA检查重度狭窄患者54例(69.23%),三组差异无统计学意义(P>0.446)。两种检查方式灵敏度、特异度、准确性差异相当(P>0.05),且两种方式检查一致性均较高(Kappa>0.7)。CDFI检查患者术后PSV、EDV均低于术前(P<0.05),CTA检查患者术后狭窄远端直径、最小残余直径均高于术前(P<0.05)。结论颈动脉重度狭窄患者术前诊断及术后随访使用CDFI及CTA诊断效能相当,与“金标准”一致性较高,且两种诊断方式对患者情况评估特点各异,可根据患者情况选择合适的诊断方式,也可将两种诊断方式进行联合提高信息获取量。

Objective To investigate the application of cervical vascular color Doppler flow imaging(CDFI)and computed tomography angiography(CTA)in preoperative diagnosis and postoperative follow-up in patients with severe carotid stenosis.Methods A total of 102 patients with carotid stenosis who needed to undergo carotid endarterectomy admitted to the hospital from March 2016 to June 2018 were enrolled.A follow-up survey was conducted for six months.Digital subtraction angiography(DSA),CDFI,and CAT examination were performed on them before surgery and after surgery followup.Taking DSA examination results as the golden standard,the detection for carotid stenosis by the two methods was observed.And the above conditions and DSA diagnosis results were performed to conduct diagnostic efficiency analysis.The stenosis of blood vessels was evaluated in preoperative and postoperative follow-up.Results Of the 78 patients,there were 58(74.35%)cases,52(66.67%)cases,and 54(69.23%)cases with severe stenosis detected by DSA,CDFI,and CTA,respectively.There was no significant difference among the three groups(P>0.446).The sensitivity,specificity and accuracy of the two examination methods were comparative(P>0.05),and the consistency of the two methods was relatively higher(Kappa>0.7).The PSV and EDV after surgery detected by CDFI were lower than those before surgery(P<0.05).The distal stenosis diameter and minimum residual diameter after surgery detected by CTA were higher than those before surgery(P<0.05).Conclusion During the preoperative diagnosis and postoperative follow-up,the diagnostic efficacy of CDFI and CTA is comparable for patients with severe carotid stenosis,and the consistency with the golden standard is relatively higher.The evaluation of patients’conditions by the two diagnostic methods is different.Appropriate diagnostic methods can be selected according to patients'conditions.The two diagnostic methods can also be combined to improve the amount of acquired information.