64层CT血管造影诊断颈内动脉狭窄及内膜切除术或支架置入术后随访的价值  

The application of 64 multidetector CT angiography in the evaluation of carotid stenosis and followup of carotid endarterectomy and percutaneous transluminal stenting

作　　者：高艳[1] 李坤成[1] 杜祥颖[1] 杨延辉[1] 刘佳宾[1] 刘建[1] 

机构地区：[1]首都医科大学宣武医院医学影像学部,北京100053

出　　处：《中华放射学杂志》2006年第9期948-952,共5页Chinese Journal of Radiology

摘　　要：目的通过与 DSA 对比,评价64层容积 CT 血管造影(CTA)诊断颈内动脉(ICA)狭窄,及其在内膜切除术和支架置入术后随访中的价值。方法同时进行 CTA 和 DSA 检查的短暂性脑缺血患者40例,根据北美症状性颈内动脉内膜剥脱术实验(NASCET)的方法,由2名不了解患者情况的放射科主任医生分别对80支颈内动脉进行 CTA 的曲面重建和 DSA 测量。以远心端颈内动脉作为参考,以 DSA 为金标准,以狭窄率50%及70%为界计算 CTA 敏感度、特异度、阴性预测值和阳性预测值等。内膜切除术和支架置入术前、术后 CTA 测得的 ICA 狭窄处直径及横切面面积的比较用配对t检验。结果以狭窄率超过70%为标准,37支血管中35支 DSA 和 CTA 检查结果一致(95%),CTA的敏感度、特异度、阴性预测值和阳性预测值分别为97%[95%可信限(CI)为85%～100%]、95%(95%CI 为82%～100%)、95%(95%CI 为82%～100%)、98%(95%CI 为92%～100%)。CTA 检测内膜切除术和支架置入术后 ICA 狭窄处直径及横切面面积较术前有显著增加,差异有统计学意义(P<0.01)。结论 CTA 是筛查 ICA 狭窄的一种有效手段,也可作为 ICA 内膜剥脱术和支架置入术后随访的首选方法。Objective To evaluate the diagnostic value of 64 multidetector-row CT angiography for internal carotid artery （ ICA ） stenosis and the application in the follow-up of carotid endarterectomy and percutaneeus transluminal stenting. Methods Forty transient ischemic attack （TIA） patients with interpretable CTA and DSA of the cervical carotid arteries were selected from May 2005 to December 2005. This yielded a total of 80 vessels. The CTA curved planar reformations （CPR） and DSA images referenced to the distal cervical internal carotid were graded by two senior neuroradiologists blindly, according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） guidelines. The paired-t test was used to verify the statistical significant difference between pre-operating and post-operating of carotid endarterectomy or pereutaneeus transluminal stenting in measuring the vascular diameter and area of cross section using CTA. Results When the 70% stenosis was used as the cut-off value, the sensitivity, specificity, negative predictive value, and the positive predicting value were 97%, 95%, 95%, and 98%, respectively. There was statistically significant difference in measuring the vascular diameter （ P 〈 0. 01 ） and area of cross section （P 〈 0. 01 ） before and after carotid endarterectomy or percutaneous transluminal stenting. Conclusions From the comparative study between CTA and DSA examination of head and neck, CTA was proved to have high sensitivity, high specificity, high negative and positive predictive value for carotid disease. CTA appears to be an excellent screening test for internal carotid stenosis and could be used for the follow-up of carotid endarterectomy and pereutaneeus transluminal stenting.

关 键 词：体层摄影术 X线计算机 血管造影术 颈内动脉狭窄 颈动脉内膜剥脱术 血管内支架 

分 类 号：R816.1[医药卫生—放射医学]