头颈CTA在脑梗死患者颈动脉粥样硬化病变评估中的应用价值

Application Value of Head and Neck CT Angiography in the Evaluation of Carotid Atherosclerosis in Patients with Cerebral Infarction

目的探讨头颈CT血管造影(CT Angiography,CTA)评估颈动脉粥样硬化狭窄程度、颈动脉斑块性质与数字减影血管造影(Digital Subtraction Angiography,DSA)诊断的一致性。方法收集河北工程大学附属医院2021年1月至2022年3月收治的脑梗死患者105例作为研究对象,对患者行头颈CTA与DSA检查,并以DSA为“金标准”,将患者分为重度狭窄30例、中度狭窄30例、轻度狭窄30例、无狭窄15例;不稳定斑块92例、稳定斑块13例。绘制受试者工作特征(Receiver Operator Characteristic,ROC)曲线分析头颈CTA对脑梗死患者颈动脉狭窄及颈动脉斑块性质的诊断价值;选择Kappa系数检验比较头颈CTA检测颈动脉粥样硬化狭窄程度、颈动脉斑块性质与DSA检查结果的一致性。结果头颈CTA检测颈动脉粥样硬化狭窄程度与DSA检查结果一致性高(Kappa=0.691,P<0.05);总体进行二分类(无狭窄为阴性,重度狭窄/中度狭窄/轻度狭窄为阳性)后,头颈CTA检测颈动脉粥样硬化狭窄、颈动脉斑块性质与DSA检查结果一致性均较高(Kappa=0.720、0.653,P<0.05)。头颈CTA对脑梗死患者颈动脉粥样硬化狭窄及颈动脉斑块性质的诊断曲线下面积分别为0.900(95%CI:0.795~0.998)、0.913(95%CI:0.821~0.998),灵敏度分别为93.3%、90.2%,特异度分别为86.7%、92.3%,阳性预测值分别为97.7%、98.8%,阴性预测值分别为68.4%、57.1%,准确度分别为92.4%、90.5%。结论头颈CTA可有效评估脑梗死患者颈动脉粥样硬化狭窄程度及颈动脉斑块性质,与DSA检查结果的一致性较高。

Objective To investigate the consistency between head and neck CT angiography(CTA)and digital subtraction angiography(DSA)in the assessment of carotid atherosclerotic stenosis degree and the nature of carotid plaque.Methods A total of 105 patients with cerebral infarction admitted to our hospital from January 2021 to March 2022 were collected as research subjects.Head and neck CTA and DSA were performed on the patients.Taking DSA as the“gold standard”,the patients were divided into severe stenosis(n=30),moderate stenosis(n=30),mild stenosis(n=30),and without stenosis(n=15).There were 92 cases with unstable plaque and 13 cases of stable plaque.Receiver operator characteristic(ROC)curve was drawn to analyze the diagnostic value of head and neck CTA for carotid stenosis and the nature of carotid plaque in patients with cerebral infarction;The Kappa coefficient test was used to compare the consistency between head and neck CTA and DSA in the detection of carotid atherosclerotic stenosis degree and the nature of carotid plaque.Results The degree of carotid atherosclerosis stenosis detected by head and neck CTA was highly consistent with that by DSA(Kappa=0.691,P<0.05).After overall classification(negative for no stenosis,positive for severe stenosis/moderate stenosis/mild stenosis),the results of head and neck CTA detection of carotid atherosclerotic stenosis and carotid plaque were highly consistent with those of DSA examination(Kappa=0.720、0.653,P<0.05).The area under curve(AUC)of head and neck CTA in the diagnosis of carotid atherosclerotic stenosis and the nature of carotid plaque in patients with cerebral infarction were 0.900(95%CI:0.795~0.998)and 0.913(95%CI:0.821~0.998)respectively,with sensitivity of 93.3%and 90.2%,specificity of 86.7%and 92.3%,positive predictive value of 97.7%and 98.8%,negative predictive value of 68.4%and 57.1%,and accuracy of 92.4%and 90.5%respectively.Conclusion Head and neck CTA can effectively evaluate the degree of carotid atherosclerotic stenosis and the nature of carotid plaque in patients with cerebral infarction,and the results of head and neck CTA are highly consistent with those of DSA.