64排螺旋CT诊断缺血性脑卒中患者颈动脉粥样斑块的价值分析

Analysis of diagnostic value of 64-slice spiral CT for carotid atherosclerotic plaques in patients with cerebral ischemic stroke

目的探讨64排螺旋CT诊断缺血性脑卒中(cerebral ischemic stroke,CIS)患者颈动脉粥样斑块情况的应用价值,为临床早期诊断CIS提供参考。方法确诊的84例CIS患者均行数字减影血管造影技术(DSA)及64排螺旋CT检查,观察患者颈动脉粥样斑块的性质、部位及颈动脉狭窄程度。以DSA检查结果为金标准,Kappa一致性评估64排螺旋CT诊断颈动脉斑块的敏感度、特异度、准确率及一致性,采用受试者工作特征(ROC)曲线分析64排螺旋CT对颈动脉斑块的诊断价值;并比较两种检查方法的图像质量。结果64排螺旋CT检测出的颈动脉狭窄程度例数、易损斑块和稳定斑块数量,与DSA检查结果差异无统计学意义(P>0.05)。64排螺旋CT检测斑块性质的灵敏度为89.66%、特异度90.24%、准确率89.90%、Kappa值为0.793,ROC曲线下面积(AUC)为0.899。64排螺旋CT检测颈总动脉、颈内动脉起始部及颈动脉分叉处颈动脉斑块的图像质量优于DSA,差异有统计学意义(P<0.05)。结论64排螺旋CT诊断CIS患者颈动脉粥样斑块情况与DSA检查结果高度一致,且图像质量优于DSA。

Objective To explore the value of 64-slice spiral CT in the diagnosis of carotid atherosclerotic plaques in patients with ischemic stroke(CIS),so as to provide reference for the early diagnosis of CIS.Methods All 84 patients diagnosedwith CIS underwent digital subtraction angiography(DSA)and a 64-slice spiral CT examination.The properties and sites of carotid atherosclerotic plaques and the severity of carotid stenosis were observed.Taking DSA results as the golden standard,the sensitivity,specificity,accuracy,and consistency of 64-slice spiral CT in the diagnosis of carotid atherosclerotic plaques were evaluated by the Kappa consistency test.The diagnostic value of 64-slice spiral CT for carotid plaques was analyzed by receiver operating characteristic(ROC)curves.The image quality of the two methods was compared.Results The difference in the number of cases with carotid stenosis,number of vulnerable plaques,and stable plaques was not statistically significant detected by 64-slice spiral CT and DSA(P>0.05).The sensitivity,specificity,accuracy,and Kappa value of 64-slice spiral CT for detecting plaque properties were 89.66%,90.24%,89.90%,and 0.793,respectively,and the area under the ROC curve(AUC)was 0.899.The image quality of plaques at the common carotid artery,initiation site of the internal carotid artery,and bifurcation of the carotid artery by 64-slice spiral CT was better than that by DSA.The difference was statistically significant(P<0.05).Conclusions The 64-slice spiral CT has high consistency with DSA in the diagnosis of carotid atherosclerotic plaques in CIS patients,and the quality of the image by 64-slice spiral CT is better than that by DSA.