轻中度颈动脉狭窄患者斑块CT血管造影特征

Plaque characteristics of CT angiography in patients with mild to moderate carotid artery stenosis

目的观察轻中度颈动脉狭窄患者高危斑块CT血管造影(CTA)特征及其诊断价值。方法纳入63例轻中度颈动脉狭窄患者、共81支狭窄动脉,根据临床表现分为有症状组和无症状组。比较组间基本资料;以组内相关系数(ICC)评价观察者间测量结果的一致性,于血管层面比较狭窄动脉斑块特征及CT参数。采用二元Logistic回归模型筛选有症状组与颈动脉狭窄相关的独立危险因素;绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC),评价根据斑块特征及CT参数诊断高危斑块的效能。结果2组患者性别、年龄及病史差异均无统计学意义(P均>0.05)。观察者测量结果的一致性均较好(ICC均>0.75,P均<0.05)。有症状组血管周围脂肪(PVAT)CT值及斑块强化值均高于无症状组(P均<0.05),且二者均为有症状颈动脉狭窄的独立危险因素。根据PVAT的CT值及斑块强化值诊断高危斑块的AUC分别为0.739和0.662,敏感度分别为70.00%和67.50%,特异度分别为80.50%和63.40%。结论PVAT的CT值和斑块强化程度可用于识别轻中度颈动脉狭窄患者的高危斑块。

Objective To observe plaque characteristics of CT angiography(CTA)in patients with mild to moderate carotid artery stenosis and the diagnostic value of high risk plaque.Methods A total of 63 patients(81 stenosis arteries)with mild to moderate carotid artery stenosis were divided into symptomatic and asymptomatic group according to clinical manifestations.Basic patient data were compared between groups.Intra-class correlation coefficient(ICC)was used to evaluate the intra-observer consistency of the measurements.The characteristics and CT parameters of plaque were compared at vascular level.Binary Logistic regression model was performed to screen independent risk factors related to carotid artery stenosis in symptomatic group.The receiver operating characteristic(ROC)curves were drawn,and the areas under the curves(AUC)were calculated to evaluate the effectiveness of plaque characteristics and CT parameters for diagnosing high-risk plaques.Results There was no significant difference of gender,age nor medical history of patients between groups(all P>0.05).The measurement results of 2 observers showed good consistency(all ICC>0.75,all P<0.05).CT value of perivascular adipose tissue(PVAT)and plaque enhancement value in symptomatic group were higher than those in asymptomatic group(both P<0.05),and both were independent risk factors for symptomatic carotid stenosis.The AUC of PVAT's CT value and plaque enhancement value was 0.739 and 0.662,sensitivity was 70.00%and 67.50%,and specificity was 80.50%and 63.40%,respectively.Conclusion Both PVAT's CT value and plaque enhancement value can be used to evaluate high-risk plaques in patients with mild to moderate carotid stenosis.