头颅CTA造影联合磁共振血管成像诊断急性缺血性脑卒中的价值

Diagnostic value of cranial CTA combined with magnetic resonance angiography in acute ischemic stroke

目的探究头颅CT血管造影(CTA)联合磁共振血管成像(MRA)在诊断急性缺血性脑卒中(AIS)中的应用价值。方法回顾性选取2018年1月至2020年1月资阳市第一人民医院收治的57例疑似AIS患者,最终确诊42例,收集患者临床资料,所有患者均行数字减影血管造影(DSA)检查及头颅CTA、三维时间飞跃法磁共振血管成像(3D-TOF MRA)检查,分析头颅CTA联合3D-TOF MRA对评估动脉狭窄度和诊断AIS的价值。结果CTA对颅内动脉轻度、中度、重度狭窄、闭塞诊断符合率分别为96.5%、72.3%、73.7%、93.0%,MRA对颅内动脉轻度、中度、重度狭窄、闭塞诊断符合率分别为96.5%、87.7%、86.9%、94.7%;MRA共检出动脉狭窄度≥50%者43例,CTA检出43例,两者联合检出46例,且狭窄度≥50%者中AIS患者比例明显高于狭窄度<50%者,差异有统计学意义(P<0.05);将MRA、CTA及联合检出狭窄度≥50%作为检验变量,将是否有AIS作为状态变量,行受试者工作曲线(ROC)分析,结果显示,头颅CTA、MRA诊断AIS的曲线下面积(AUC)为0.852、0.860,联合诊断的AUC为0.904,诊断价值均较为理想,且以联合诊断价值最高。结论头颅CTA与MRA均可有效评价颅脑血管疾病患者动脉狭窄程度,而两者联合诊断AIS的临床价值更高。

Objective To explore the application value of cranial CT angiography(CTA)combined with magnetic resonance angiography(MRA)in the diagnosis of acute ischemic stroke(AIS).Methods Fifty-seven patients with intracranial artery stenosis(AIS or transient ischemia)admitted to the First People's Hospital of Ziyang from January 2018 to January 2020 were selected,and their clinical data was collected.All patients received digital subtraction angiography(DSA)examination and cranial CTA,3D-TOF MRA to analyze the value of cranial CTA combined with 3D-TOF MRA in the evaluation of arterial stenosis and AIS.Results There were 42 patients with AIS.The diagnostic coincidence rates of CTA for the diagnosis of mild,moderate,severe stenosis and occlusion of the intracranial artery were 96.5%,72.3%,73.7%,and 93.0%,respectively.The diagnostic coincidence rates of MRA for mild,moderate,severe stenosis and occlusion of intracranial arteries were 96.5%,87.7%,86.9%,and 94.7% respectively.MRA detected 43 cases with arterial stenosis≥50%,and CTA detected 43 cases,those two combined detected 46 cases,and the proportion of AIS patients with stenosis≥50% was significantly higher than those with stenosis<50%(P<0.05).ROC analysis was performed based on MRA,CTA and combined detection of stenosis degree≥50% as the test variable,and presence/absence of AIS as the state variable.The results show that the AUC of the cranial CTA and MRA to diagnose AIS was 0.852 and 0.860,and the combined AUC was 0.904.The diagnostic value was relatively ideal,and the joint diagnosis had the highest value.Conclusion Both cranial CTA and MRA can effectively evaluate the degree of arterial stenosis in patients with cerebrovascular disease,and the combined diagnosis of AIS is of higher clinical value.