CT血管造影和颈动脉超声测量脑梗死患者颅外颈动脉狭窄的比较  

Extracranial carotid stenosis in Chinese patients with ischemic stroke as indicated by spiral CT angiography and ultrasonography

作　　者：沈介明[1] 胡锦清[2] 张仲伟[3] 乙芳[4] 凌华威[3] 汤荟冬[1] 王瑛[1] 

机构地区：[1]上海第二医科大学附属瑞金医院神经内科,上海200025 [2]上海第二医科大学附属瑞金医院神经外科,上海200025 [3]上海第二医科大学附属瑞金医院放射科,上海200025 [4]上海第二医科大学附属瑞金医院临床超声波科,上海200025

出　　处：《诊断学理论与实践》2004年第3期173-175,188,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:颈动脉粥样硬化是脑梗死的主要发病原因之一,本研究比较CT血管造影(CTA)和颈动脉超声(US)检测缺血性脑梗死患者颅外颈动脉狭窄的情况。方法:对34例急性颈内动脉支配区脑梗死的住院患者,在发病后2周内作CTA和US检查,并对其中的3例进行了DSA检查。颈内动脉段的狭窄率按北美症状性颈动脉内膜剥脱术研究(NASCET)法进行计算,颈总动脉及颈膨大的狭窄率根据欧洲颈动脉外科手术研究(ECST)法进行计算。结果:34例中30例(88.2%)发现颈动脉斑块,CTA和US测得颈动脉狭窄率分别为34.6%±17.8%和32.5%±13.9%,两者对狭窄程度判断的一致性为70.9%。以DSA为金标准参考时,CTA正确诊断1例颈内动脉完全闭塞,但被US低估为50%狭窄。CTA发现40/80钙化斑块(50.0%),US发现23/80钙化斑块(28.8%)。此外,US发现的1处斑块溃疡,未能在CTA显示。结论:CTA和US作为快速的无创伤的检测血管形态的技术,在诊断颅外颈动脉狭窄方面具有互补作用。Objective To compare the findings of extracranial carotid stenosis detected by computerized tomographic angiography (CTA) and ultrasonography (US) in patients with ischemic stroke. Methods Thirty-four inpatients with acute ischemic stroke in the carotid artery territory underwent CTA (reconstructing 3-D images with maximal intensity projection) and US within 2 weeks after the onset. The intra-arterial digital subtract angiography (DSA) was performed in 3 patients as well. The degree of stenosis in each segmental artery was calculated according to the formula recommended by NASCET and ECST. Results Among 34 cases, thirty patients (88.2%) were diagnosed as extracranial carotid atherosclerosis. The stenosis ratios were (34.6±17.8)% and (32.5±13.9)% detected by CTA and US respectively. The overall agreement of the stenosis grades obtained from two methods was 70.9%. When DSA was used as the reference standard, one patient with intracranial aneurysm (ICA) occlusion was diagnosed correctly by CTA, which was misinterpreted as 50% stenosis by US. CTA identified more calcified plaques (40/80, 50.0%) than US did (28/80, 28.8%). In addition, US disco-vered an ulcer in one patient but missed by CTA. Conclusions CTA and US are complementing in diagnosing the extracranial carotid stenosis.

关 键 词：脑梗死 颅外颈动脉狭窄 CT血管造影 颈动脉超声 粥样硬化斑块 数字减影动脉造影 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]