64排螺旋CT血管造影诊断椎动脉起始段狭窄的价值  

The application of 64 multidetector CT angiography in the evaluation of proximal vertebral artery stenosis

作　　者：于淑靖[1] 孔令俊[1] 刘慧生[1] 

机构地区：[1]河北省沧州市中心医院CT室,河北沧州061001

出　　处：《中国临床医学影像杂志》2009年第1期9-12,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:通过与数字减影(DSA)对比,评价64排螺旋CT血管造影(CTA)诊断椎动脉起始段狭窄的价值。方法:2005年12月～2008年4月同时行DSA与CTA检查的临床脑血管病患者398例。采用NASCET标准,由两名高年资医师分别对398例共796条椎动脉进行CTA与DSA测量,以远心端椎动脉作参考,用敏感性、特异性、阳性预测值和阴性预测值评价CTA诊断椎动脉狭窄的价值,用卡方检验评价CTA与DSA检测椎动脉斑块的差异有否显著意义。结果:①以DSA为金标准,CTA诊断椎动脉起始段狭窄的阴性预测值为100%。敏感性、特异性、阳性预测值分别为100%,97.6%,93.9%。②以DSA为金标准,CTA诊断椎动脉起始段≥50%狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为100%,97.3%,82.1%,100%。③以DSA为金标准,CTA诊断<50%向心性狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为92.0%,100%,100%,99.5%;CTA诊断<50%偏心性狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为78.3%,98.1%,79.4%,97.9%。阳性预测值较低与DSA假阴性有关。④CTA检测椎动脉斑块较DSA有显著差异,χ2=27.26,P<0.05。结论:CTA诊断椎动脉起始段狭窄有很高的敏感性、特异性和阴性预测值,对偏心性狭窄和斑块的评估能力优于DSA,是诊断椎动脉起始段狭窄的可靠手段。Objective： To evaluate the diagnostic value of 64 multidetector CT angiography （CTA） for proximal vertebral artery stenosis compared with digital subtraction angiography （DSA）. Methods： All patients with interpretable CTA and DSA of the proximal vertebral arteries from Dec. 2005 to Apr. 2008 were included in this study. This yieled a total of 796 vessels. Two senior neuroradiologists graded the CTA and DSA images referring to the distal vertebral artery, according to the North American Symptomatic Carotid Endarterectomy Trial guidelines. Comparison of CTA with DSA in detecting the soft plaque of vertebral artery. Statistical significance was determined using X2 test. Results： Referring to the DSA, the overall sensitivity, specificity, positive predictive value and negative predictive value to diagnose proximal vertebral artery stenosis by 64 MSCT were 100%, 97.6%, 93.9% and 100% respectively, and were 100%, 97.3%, 82.1%, 100% respectively when proximal vertebral artery with stenosis ≥50%, and were 92.0%, 100%, 100%, 99.5% respectively when proximal vertebral artery had central stenosis〈50%, and were 92.0%, 100%, 100%, 99.5% respectively when proximal vertebral artery had eccentric stenosis〈50%. There was statistically significant difference in detecting soft plaque between CTA and DSA （P〈O.05）. Conclusions： CTA has a high sensitivity, high specificity, high negative predictive value for proximal vertebral artery stenosis, and has a higher accura- cy in evaluating soft plaque and proximal vertebral artery eccentric stenosis than DSA. CTA appears to be an excellent evaluating test for proximal vertebral artery stenosis.

关 键 词：椎底动脉供血不足 血管造影术 数字减影 体层摄影术 螺旋计算机 

分 类 号：R543.5[医药卫生—心血管疾病] R814.42[医药卫生—内科学]