颈动脉血管超声与CTA在颈动脉狭窄诊断中结果不一致的原因分析

Analysis of the reasons for the inconsistency between carotid vascular ultrasound andcomputed tomography angiography in the diagnosis of carotid artery stenosis

目的探讨分析颈动脉血管超声与CT血管成像(CTA)在颈动脉狭窄诊断中结果不一致的原因。方法回顾性分析2018年1月至2022年10月在广州医科大学附属第三医院收治的53例同时行颈动脉血管超声和CTA的患者,其中男性39例,女性14例,年龄(74.70±9.31)岁。记录颈动脉血管超声和CTA检查中颈内动脉(ICA)、颈总动脉(CCA)的血管情况,共计212条血管。比较分析颈动脉血管超声和CTA诊断结果是否一致,两者狭窄检出率以及检测狭窄程度是否存在差异性。统计学方法采用χ^(2)检验、Kappa一致性检验。结果颈动脉血管超声与CTA在颈动脉狭窄检出率上对比,差异有统计学意义(χ^(2)=33.71,P<0.05)。其中,两种检测方法在检测CCA是否狭窄上对比,差异无统计学意义(χ^(2)=2.80,P>0.05);在检测ICA是否狭窄上,差异有统计学意义(χ^(2)=11.98,P<0.05)。超声和CTA在CCA重度狭窄及闭塞检测上对比,差异无统计学意义(χ^(2)=0.70,P>0.05)。超声和CTA在ICA重度狭窄及闭塞检测上对比,差异有统计学意义(χ^(2)=43.19,P<0.05)。以CTA检查结果为金标准,颈动脉血管超声检测颈动脉中重度狭窄的灵敏度为78.79%,特异度为90.50%,误诊率为9.50%,漏诊率为21.21%。颈动脉血管超声诊断颈动脉轻度狭窄、中度狭窄、重度狭窄、完全闭塞以及未见狭窄的准确率分别为1.5%、46.9%、78.6%、80.0%、87.5%。在诊断颈动脉狭窄的狭窄程度上,颈动脉血管超声和CTA具有一致性(Kappa=0.335,P<0.05)。结论颈动脉血管超声在临床上作为筛查颈动脉狭窄首选的检查方法,其诊断狭窄程度上和CTA具有一致性。在检测CCA重度狭窄及闭塞上,超声和CTA具有一致性。在检测颈动脉轻度狭窄上,超声和CTA存在差异,主要体现在超声对轻度狭窄病变的检出率较低。超声医生应加强对血管超声指南的学习,熟练对使用仪器进行相关参数的调节,进一步提高临床诊断准确率,为颈动脉狭窄患者诊疗提供更有力的依据。

Objective To analyze and explore the reasons for the inconsistency between carotid vascular ultrasound and computed tomography angiography(CTA)in the diagnosis of carotid artery stenosis.Methods A retrospective analysis was performed on 53 patients who underwent carotid vascular ultrasound and CTA in the Third Affiliated Hospital of Guangzhou Medical University from January 2018 to October 2022.There were 39 males and 14 females,aged(74.70±9.31)years.The internal carotid artery(ICA)and common carotid artery(CCA)blood vessels were recorded under carotid vascular ultrasound and CTA,with a total of 212 blood vessels.Whether the diagnosis results of carotid vascular ultrasound and CTA were consistent,and whether there were differences in the detection rate of stenosis and the degree of stenosis detected between the two test methods were analyzed.Statistical methods used wereχ^(2) test and Kappa consistency test.Results There was a statistically significant difference in the detection rate of carotid artery stenosis between carotid vascular ultrasound and CTA(χ^(2)=33.71,P<0.001).There was no statistically significant difference in the detection of CCA stenosis between the two detection methods(χ^(2)=2.80,P>0.05),but there was a statistically significant difference in the detection of ICA stenosis between the two detection methods(χ^(2)=11.98,P<0.05).There was no statistically significant difference in the detection of severe stenosis and occlusion of CCA between the two detection methods(χ^(2)=0.70,P>0.05),but there was a statistically significant difference in the detection of severe stenosis and occlusion of ICA between the two detection methods(χ^(2)=43.19,P<0.05).Taking CTA as the gold standard,the sensitivity,specificity,misdiagnosis rate,and missed diagnosis rate of carotid artery ultrasound for detecting moderate and severe carotid artery stenosis were 78.79%,90.50%,9.50%,and 21.21%,respectively.The accuracy rates of carotid artery ultrasound in the diagnosis of mild stenosis,moderate stenosis,severe stenosis,complete occlusion,and no stenosis of the carotid artery were 1.5%,46.9%,78.6%,80.0%,and 87.5%,respectively.Carotid vascular ultrasound was consistent with CTA in the diagnosis of degree of carotid artery stenosis(Kappa=0.335,P<0.05).Conclusions As the preferred test for clinical screening of carotid artery stenosis,the degree of carotid artery stenosis diagnosed by carotid vascular ultrasound is consistent with CTA.Ultrasound and CTA are consistent in detecting severe stenosis and occlusion of CCA.In the detection of mild carotid artery stenosis,there is a difference between ultrasound and CTA,mainly reflecting in a lower detection rate of ultrasound for mild stenosis lesions.Therefore,sonographers should strengthen the study of vascular ultrasound guidelines,skillfully adjust the relevant parameters of used instruments,further improve the accuracy of clinical diagnosis,and provide a stronger basis for the diagnosis and treatment for patients with carotid artery stenosis.