CTA与多普勒超声检查在下肢动脉硬化闭塞症诊断中的对比分析

Comparative study of CT angiography and color doppler ultrasound in the diagnosis of lower extremity arteriosclerotic obstruction

目的探讨CT血管造影(CTA)与多普勒超声(DUS)检查在下肢动脉硬化性闭塞症(ASO)中的诊断效能。方法选取我院经数字减影血管造影(DSA)检查并接受腔内血管成形术治疗的80例ASO患者。以DSA作为金标准,对比患者术前CTA及DUS诊断ASO的效能及一致性。结果CTA对全段下肢动脉及髂动脉段≥50%血管狭窄及闭塞的检出率分别较DUS高4.89%(P=0.002)和2.29%(P=0.007)。CTA对下肢全段≥50%血管狭窄及腘上动脉段管腔闭塞的诊断效能及一致性均高于DUS(敏感性:81.47%~96.84%vs 80.35%~89.66%;特异性82.39%~90.75%vs 82.16%~87.25%;Kappa值:0.82~0.98 vs 0.79~0.94),而对腘下动脉段血管闭塞的评估表现不及DUS(敏感性:77.83%vs 78.49%;特异性:72.15%vs 79.28%;Kappa值:0.72 vs 0.76)。结论CTA对ASO患者的血管评估效能总体优于DUS,而对于腘下动脉段血管重度狭窄及闭塞仍需联合DUS综合评估,以制定最佳临床治疗方案。

Objective This study aimed to evaluate and compare the diagnostic performance of computed tomography angiography(CTA)and duplex ultrasonography(DUS)in arteriosclerotic obstruction(ASO)of the lower limb arteries.Methods This retrospective study included 80 ASO patients who underwent digital subtraction angiography(DSA)and intravascular angioplasty treatment at our hospital.The diagnostic performance and agreement of preoperative CTA and DUS in diagnosing ASO were compared using DSA as the gold standard.Results CTA had a higher detection rate than DUS for≥50%stenosis or occlusion in the entire lower limb arteries and the iliac artery segment with differences of 4.89%(p=0.002)and 2.29%(P=0.007),respectively.CTA showed higher diagnostic performance and agreement than DUS for≥50% stenosis in the entire lower limb and the above popliteal artery segments(sensitivity:81.47%~96.84%vs 80.35%~89.66%;specificity:82.39%~87.25%vs 82.16%~90.75%;Kappa value:0.82~0.98 vs 0.79~0.94).However,CTA was less effective than DUS in evaluating arterial occlusion in the below popliteal artery segments(sensitivity:77.83%vs 78.49%;specificity:72.15%vs 79.28%;Kappa value:0.72 vs 0.76).Conclusion CTA shows overall better vascular assessment performance than DUS in ASO patients,but a combined evaluation with DUS is still necessary for severe stenosis or occlusion in the below popliteal artery segment to determine the optimal clinical treatment strategy.