大范围颈动脉MDCTA与DSA的对照研究  

Comparative Study of Multiple Detector Row Spiral CT Angiography (MDCTA) of Carotid Artery with the Digital Subtraction Angiography (DSA)

作　　者：周建军[1] 周康荣[1] 陈祖望[1] 吴东[1] 陈惠明[1] 陈刚[1] 陈锦[1] 缪熙音[1] 张利军[1] 陆秀良[1] 刘豪[1] 

机构地区：[1]复旦大学附属中山医院放射科上海市影像医学研究所,200032

出　　处：《临床放射学杂志》2006年第1期75-78,共4页Journal of Clinical Radiology

摘　　要：目的通过比较MDCTA与DSA对颈动脉病变的诊断差异以期评价MDCTA的临床应用价值。材料与方法(1)搜集经颈动脉DSA和MDCTA检查的临床病例19例。(2)随机选择实验动物猪10头,通过导丝损伤和外科手术建立猪颈动脉血管腔内、腔外狭窄模型,行DSA和MDCTA造影对照。根据国外采用的分类方法并结合血管外科手术与否的判断标准,以50%为界将狭窄程度分成两组,分别评价MDCTA诊断价值。数据分析采用诊断实验评价。结果DSA检查正常13例中,MDCTA正常12例,1例误诊为轻度狭窄。狭窄血管56处,MDCTA漏诊3处。MDCTA对颈动脉狭窄程度的判断与DSA有很好的相关性,敏感性为94.6%,特异性为92.3%,准确性94.2%,阳性预测值为98.2%,阴性预测值为80.0%。其中,狭窄在50%以下者37处,CTA漏诊3处,敏感性为91.9%;狭窄超过50%者19处,MDCTA无漏诊,敏感性为100%。MDCTA显示病灶不规则内表面4例,斑块溃疡3例,均经病理标本证实,而DSA显示不规则2例,溃疡1例。结论颈动脉MDCTA可以取代诊断用途的DSA。在显示血管狭窄的形态、斑块表面不规则、斑块溃疡以及重度狭窄后血管等方面,大范围颈动脉MDCTA更有优势。Objective To evaluate the image quality and the diagnostic value of MDCTA of carotid artery by comparing with that of digital subtraction angiography. Materials and Methods （1）19 patients with DSA and MDCTA were collected. （2）10 pigs were randomly selected to be performed carotid stenosis model by operation, then DSA and MDCTA were underwent to compare the image quality respectively, results were generally evaluated by three experienced radiologists. Results In 13 cases with normal carotid artery were detected by DSA, 12 cases was judged as normal and one misdiagnosed as stenosis by MDCTA. In 56 stenosis vessels, 3 were missed by MDCTA. There was significant correlation between MDCTA and DSA for evaluation of the degree of stenosis, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 94.6 %, 92.3 %, 94.2%, 98.2%, 80.0% respectively. In 37 of 56 stenosis vessels, the stenosis was less than 50%, 3 were missed by MDCTA, the sensitivity of detection was 91.9% ; meanwhile, the detectability by MDCTA was 100% for vessels with stenosis over 50% （19 of 19）. 4 irregular plaques and 3 plaque ulcerations were demonstrated by MDCTA confirmed by pathology, and 2 irregular plaques and 1 plaque ulcerations were detected by DSA. Conclusion There is significant correlation between MDCTA and DSA for diagnosing stenosis of carotid artery, MDCTA have advantage in demonstrating the plaque morphology and plaque ulceration.

关 键 词：颈动脉 猪 多排螺旋CT CT血管成像 数字减影血管造影 狭窄 

分 类 号：R816.2[医药卫生—放射医学]