颈动脉中重度狭窄内膜切除术前后CTA定量参数的变化分析

Changes of Quantitative Parameters of CTA Before and After Carotid Endarterectomy for Moderate and Severe Carotid Stenosis

目的 观察并分析颈动脉中重度狭窄患者行内膜切除术(CEA)前后电子计算机断层扫描血管造影(CTA)定量参数的变化。方法 将128例行CEA患者纳为本次研究对象,分别以彩色多普勒超声(CDUS)和CTA检查患者术前颈动脉狭窄程度,并与数字减影血管造影(DSA)的检查结果相比较,分析两种检查方式诊断颈动脉狭窄程度的准确率(灵敏度、特异度、准确率、阳性预测值、阴性预测值),患者术后随访时分别行CDUS和CTA检查并分析患者颈动脉定量参数变化[CDUS定量参数:狭窄段收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV);CTA定量参数:狭窄远端直径、最小残余直径]。结果 经一致性分析证实CTA与CDUS评估颈动脉狭窄程度的灵敏度分别为95.40%、94.25%,特异度分别为85.37%、73.17%,准确率分别为92.19%、87.5 0%,阳性预测值分别为9 3.2 6%、88.17%,阴性预测值分别为89,74%、85.71%,Kappa分别为0.818、0.701。本研究手术成功104例,失败24例,手术成功率81.25%。术后CTA检查参数显示狭窄远端直径及最小残余直径均显著大于术前(P<0.05);术后CDUS检查参数显示PSV及EDV均显著小于术前(P<0.05)。结论 颈动脉CTA对诊断颈动脉狭窄程度及了解斑块的稳定性具备较高的临床应用价值,分析CTA在CEA术前及术后检查出的定量参数变化,可精确反映CEA术后患者颈动脉管腔的改善水平,值得临床推广运用。

Objective The changes of quantitative parameters of computed tomography angiography(CTA)in patients with moderate and severe carotid stenosis before and after Carotid endarterectomy(CEA)were observed and analyzed.Methods 128 patients with CEA were included in this study.The degree of preoperative carotid stenosis was examined by color doppler ultrasound(CDUS)and CTA,and compared with the results of digital subtraction angiography(DSA).The accuracy(sensitivity,spe cificity,accuracy,positive predictive value and negative predictive value)of the two examination methods in the diagnosis of carotid stenosis were analyzed.CDUS and CTA were performed during postoperative follow-up,and the changes of quantitative parameters of carotid artery were analyzed[CDUS quantitative parameters:peak systolic blood flow velocity(PSV)and end diastolic blood flow velocity(EDV);CTA quantitative parameters:distal diameter and minimum residual diameter of stenosis].Results Consistency analysis confirmed that the sensitivity,specificity,accuracy,,positive predictive value,negative predictive value and kappa of CTA in assessing the degree of carotid artery stenosis were 95.40%,85.37%,92.19%,93.26%,89.74%and 0.818 respectively;consistency analysis confirmed that the sensitivity,specificity,accuracy,,positive predictive value,negative predictive value and kappa of CDUS in assessing the degree of carotid artery stenosis were 94.25%,73.17%,87.50%,88.17%,85.71%and 0.701 respectively.In this study,104 cases were successfully operated and 24 cases failed,with a success rate of 81.25%.Postoperative CTA parameters showed that the distal diameter and minimum residual diameter of stenosis were significantly greater than those before operation(P<0.05).Postoperative CDUS parameters showed that PSV and EDV were significantly lower than those before operation(P<0.05).Conclusion Carotid artery CTA has high clinical application value in diagnosing the degree of carotid artrey stenosis and understanding the stability of plaques.Analyzing the changes of quantitative parameters detected by CTA before and after CEA can accurately reflect the improvement level of carotid lumen after CEA,which is worthy of clinical application.