MSCT血管成像对下肢缺血性病变的筛查价值

The value of MSCT angiography in screening of lower limb ischemic lesions

目的探讨MSCT血管成像对下肢缺血性病变的筛查价值。方法分析30例临床疑似下肢缺血患者的CTA图像,与DSA对比。每例下肢动脉分13节段,狭窄程度分四级。双盲法对图像质量、狭窄程度、斑块性质进行分析。以DSA为标准,评价CTA准确性。Kappa检验评价CTA与DSA评估下肢动脉狭窄的一致性。配对卡方检验验证二者评价下肢动脉显著狭窄的差异性,P<0.05有统计学意义。对腹主动脉、双侧髂动脉共90段血管,比较横断位图像与重建图像的准确性。结果390节段中,CTA诊断准确的365段,25段诊断不够准确,其中17段合并严重钙化,诊断符合率93.6%。CTA与DSA诊断下肢动脉狭窄有良好的一致性(Kappa=0.914),二者诊断能力无差异性(2=6,P=0.791)。腹主动脉、双侧髂动脉水平,横断位图像准确率较高。结论MSCT血管成像能够准确评估下肢动脉狭窄程度,成像质量高,是筛查下肢缺血病变的可靠方法。

Objective To explore the value of MSCT angiography in screening ischemic lesions of lower extremities.MethodsThe CTA images of 30 patients with suspected lower limb ischemia were analyzed and compared with DSA.Each lower extremity artery was divided into 13 segments,and the degree of stenosis was divided into four levels.The double-blind method was used to analyze the image quality,stenosis and plaque properties.DSA was used as the standard to evaluate the accuracy of CTA.Kappa test was used to evaluate the consistency of CTA and DSA in the diagnosis of lower extremity arterial stenosis.The paired chi-square test was used to verify the difference between the two to evaluate the significant stenosis of the lower extremity arteries,P<0.05 was considered statistically significant.For a total of 90 segments of abdominal aorta and bilateral iliac arteries,the accuracy of the cross-sectional image and the reconstructed image were compared.Results Of the 390 vascular segments,365 segments were diagnosed accurately,and 25 segments were not accurate enough and 17 of them were combined with severe calcification.The diagnostic coincidence rate was 93.6%.The diagnosis of arterial stenosis in lower extremities by CTA and DSA was in good agreement(Kappa=0.914),and there was no difference in diagnosis between them(2=6,P=0.791).At the level of the abdominal aorta and bilateral iliac arteries,the accuracy of the image in the transverse position was high.Conclusion MSCT angiography can accurately diagnose the degree of arterial stenosis of lower extremities,and the imaging quality is high,which is a reliable method for screening ischemic lesions of the lower extremities.