计算机断层扫描血管造影对于颅内外支架留置术后随访诊断意义及相关因素分析

Diagnostic value and related factors about computed tomography angiography after intracranial and extracranial stents placement

目的探究计算机断层扫描血管造影(computed tomography angiography,CTA)对于颅内外支架留置术后随访的诊断准确性及相关影响因素。方法收集2016年12月到2019年11月的颅内和颅外支架留置术患者共26例进行回顾性研究。其中男性18例、女性8例;平均年龄(62.6±10.6)岁,支架37枚;全部使用CTA和数字减影血管造影(digital subtraction angiography,DSA)进行随访。以DSA为评判标准,将CTA的支架内动脉显影质量进行分级,并将分级结果与包括支架所在动脉的直径、位于颅内或颅外、是否紧贴颅骨走行以及临近弹簧圈存在与否诸因素的相关性,进行统计分析。结果支架内的动脉成像质量与动脉直径密切相关,使用Youden指数得出血管直径的最佳界值为2.5 mm。在颅内、颅外两组间差异有统计学意义(P<0.001);支架内动脉的成像质量在是否紧贴颅骨走行两组间差异无统计学意义(P=0.321);在弹簧圈的有、无两组间差异有统计学意义(P<0.001)。结论颅内外动脉留置支架术后,CTA随访的准确性与支架所在动脉直径相关,大于2.5 mm时具有较高的准确性;颅骨对成像质量无明显影响;临近的弹簧圈对成像质量有严重影响。

Objective To investigate the diagnostic accuracy and related affecting factors of computed tomography angiography(CTA)after intracranial and extracranial stents placement.Methods A total of 26 patients with intracranial and extracranial stent placement from December 2016 to November 2019 were retrospectively reviewed.There are 18 males and 8 females with the mean age(62.6±10.6)years and 37 stents were placed.All of them were followed up by CTA and digital subtraction angiography(DSA).CTA imaging quality inside stents was graded according to follow up DSA.The related factors including the diameter of the artery,the intracranial or extracranial,close to skull or not,presence or absence of the coil,were analyzed statistically.Results The imaging quality grade of in the stent was closely related to the diameter of the artery.According to the Youden index,the best cut-off value for the vessel diameter was 2.5 mm.There was significant difference between the intracranial and extracranial groups(P<0.001).There was no significant difference of imaging quality between the two groups,stay close to the skull or not(P=0.321).There was significant difference between the two groups about the coil existence(P<0.001).Conclusion After intracranial and extracranial stents placement,the accuracy of CTA follow-up is related to the diameter of the artery where the stent is located.When it is larger than 2.5 mm,it seems to have higher accuracy.The skull has no influence on image quality.The adjacent coils seriously attenuate the image quality.