彩色双功能超声与计算机断层扫描测量腹主动脉瘤最大径的比较  

Comparison of computed tomography angiography with colorduplex ultrasonography for measuring the maximal diameter of abdominal aortic aneurysm

作　　者：李炜淼[1] 陈斌[1] 郭大乔[1] 董智慧[1] 竺挺[1] 

机构地区：[1]复旦交通大学附属中山医院血管外科,上海200032

出　　处：《上海医学》2013年第4期354-357,共4页Shanghai Medical Journal

基　　金：2007年上海市卫生局青年科研项目资助(2007Y37)

摘　　要：目的采用不同的彩色双功能超声(CDU)测量方法及计算机断层扫描血管造影(CTA)测量腹主动脉瘤的最大径,并进行比较,评估其相关性及一致性,以期获得具有临床意义的最佳测量方法。方法收集年4月—2011年6月初步诊断为腹主动脉瘤的77例患者,分别应用CDU及CTA测量腹主动脉瘤的最大径。CTA测得腹主动脉瘤的最大径记为CT_max;不同的CDU测量方法测得的腹主动脉瘤最大径包括最大截面的前后位内膜-内膜(DUAP_i)、前后位外膜-外膜(DUAP_a)、横径(DU_trans)及任意方向上的最大径(DU_max)。将不同的CDU测量方法测得的结果分别与CTA测量的CT_max进行比较,采用线性回归分析评估其间相关性;采用Bland-Altman法评估其间的一致性,并以两者结果相差-5～5mm内作为临床可接受范围。结果 CTA测得的CT_max值显著高于不同CDU测量方法测得DUAP_i、DUAP_a、DU_trans、DU_max值(P值均<0.05)。线性回归分析显示,CT_max与DUAP_i、DUAP_a、DU_trans、DU_max呈正相关(r值分别为0.968、0.969、0.947、0.990,P值均<0.05)。Bland-Altman法显示,CT_max与DUAP_i、DUAP_a、DU_trans、DU_max的一致性限度(LOA)分别为(-0.43～12.43)、(-3.80～8.70)、(-3.54～12.68)和(-3.08～4.10)mm,仅DU_max方法结果在临床可接受范围内。结论 CDU测量DU_max代替CTA测量是可行的,CDU测量DUAP_i、DUAP_a、DU_trans可能造成结果偏差太大而影响临床诊断。Objective To assess the agreement of various color duplex ultrasonography （CDU） measurements with computed tomography angiography （CTA） for measuring the maximal diameter of abdominal aortic aneurysm. Methods From April 2010 to June 2011, 77 patients were diagnosed as abdominal aortic aneurysm in our center. CDU and OTA were applied in all patients before intervention. Maximal aortic diameter was recorded from intimal to intimal in the anteroposterior plane （DUAP it, adventitia to adventitia in the anteroposterior plane （DUAP_a）, transverse plane （DU_trans） and at any direction （DU_max） by CDU. The CDU data were compared with maximal diameter obtained by CTA （CT_max）. Correlation was assessed with linear regression analysis. Agreement between different measurements was evaluated according to the principles of Bland-Altman plots. Limits of agreement （LOA） between - 5 mm and 5 mm were regarded as clinically acceptable. Results CT_max were significantly higher than DUAP_i, DUAP_a, DU_trans and DU_max （all P~ 0.05）. The correlation coefficients between CTA and the four CDU methods （DUAP_i, DUAP_a, DU_trans and DU_max） were 0. 968, 0. 969, 0. 947 and 0. 990, respectively （all P^0. 057. In Bland-Altman plots, the LOAs of the four pairs were -0.43to 12.43, --3.80 to 8.70, -3.54 to 12.68 and --3.08 to 4.10 mm, respectively. Only DU_max was clinically acceptable. Conclusion All CDU measurements correlate with CTA measurement, but only DU_max is in good agreement with CTA. Thus, replacing CTA with CDU is feasible only when applying the DU_max methodology.

关 键 词：彩色双功超声 计算机断层扫描 腹主动脉瘤 动脉瘤最大径 

分 类 号：R735[医药卫生—肿瘤]