无创影像检查方法诊断糖尿病下肢动脉病变的价值  

Diagnostic value of non-invasive imaging modalities to evaluate lower limb arterial disease associated with diabetes

作　　者：黄强[1] 王剑锋[1] 翟仁友[1] 张杨[1] 杨伟利[1] 魏宝杰[1] 高堃[1] 

机构地区：[1]首都医科大学附属北京朝阳医院介入放射科,100020

出　　处：《中华放射学杂志》2015年第1期20-24,共5页Chinese Journal of Radiology

摘　　要：目的探讨无创影像检查方法诊断糖尿病下肢动脉病变的价值。方法回顾性分析临床诊断为糖尿病导致的下肢动脉狭窄或闭塞病变，且一侧或双侧下肢动脉行DSA和无创影像检查的227例患者（292条下肢动脉）。无创影像检查方法包括CTA、三维增强MRA（CE—MRA）和彩色多普勒超声（DUS）中的至少1种。共169条下肢动脉行CTA检查，123条下肢动脉行CE—MRA检查，194条下肢动脉行DUS检查。对血管进行分支分级，将血管分为1级（膝上动脉）、2级（膝下动脉）和3级（足背动脉）。以DSA结果为金标准，分别计算CTA、CE—MRA和DUS诊断下肢动脉中、重度狭窄病变的效能，并采用一致性分析评价DSA和无创影像检查方法诊断不同下肢血管分支分级中、重度狭窄病变的一致性。结果CTA诊断糖尿病下肢1、2、3级动脉中度狭窄的敏感度分别为100％（56／56）、97．6％（82／84）和93．8％（30／32），诊断重度狭窄的敏感度分别为100％（19／19）、94．4％（34／36）和61．5％（8／13）；诊断中、重度狭窄的准确度为95．9％（162／169）～99．4％（168／169）；与DSA诊断结果一致性较好，Kappa值为0．760～0．916，P〈0．05。CE—MRA诊断糖尿病下肢1、2、3级动脉中度狭窄的敏感度分别为93．2％（68／73）、97．2％（103／106）和93．2％（69／74），诊断重度狭窄的敏感度分别为91．3％（21／23）、80．8％（42／52）和42．1％（8／19）；诊断中、重度狭窄的准确度为86．2％（106／123）～96．7％（119／123）；与DSA诊断结果一致性较好，Kappa值为0．767～0．868，P〈0．05。DUS诊断糖尿病下肢1、2、3级动脉中度狭窄的敏感度分别为89．9％（62／69）、88．8％（87／98）和79．2％（42／53），诊断重度狭窄的敏感度分别为73．1％（19／26）、84．8％（39／46）和44．4％（8／18）；诊断中、重度狭窄的准确度为89．Objective To evaluate the diagnostic value of non-invasive imaging modalities to evaluate lower limb arterial disease associated with diabetes. Methods Two hundred and twenty seven patients （292 lower limb arteries） with lower limb arterial disease due to diabetes underwent both DSA and one of the pre-operative imaging modalities including CTA, CE-MRA and DUS were included in this study. The diagnostic consistency of CT angiography（CTA）, contrast enhanced magnetic resonance angiography （CE-MRA） and Doppler ultrasonography（DUS） compared with DSA were calculated respectively. CTA was performed in 169 lower limb arteries, while 123 in CE-MRA and DUS in 192. DSA was used as the gold standard. Consistency analysis was performed to evaluate the three imaging modalities with lower limb artery classified as Grade 1, Grade 2 and Grade 3. Results The sensitivity of CTA to evaluate mild stenosis in Grade 1 to Grade 3 was 100%（56/56）,97.6%（82/84） and 93.8%（30/32） respectively,while 100%（19/19）, 94.4% （34/36）and 61.5% （8/13） for severe stenosis. The diagnostic accuracy of mild and severe stenosis was 95.9% （162/169） to 99.4% （168/169）, which showed good consistency with the resuh of DSA with Kappa value of 0.760 to 0.916, and P〈0.05. The sensitivity of CE-MRA to evaluate mild stenosis in Grade 1 to Grade 3 was 93.2% （68/73）,97.2% （103/106） and 93.2% （69/74） respectively, while 91.3% （21/23）, 80.8% （42/52）and 42.1% （8/19）for severe stenosis. The diagnostic accuracy of mild and severe stenosis was 86.2% （106/123） to 96.7% （119/123）, which showed good consistency with the result of DSA with Kappa value of 0.767 to 0.868 and P〈0.05. The sensitivity of DUS to evaluate mild stenosis in Grade 1 to Grade 3 was 89.9% （62/69）,88.8% （ 87/98 ） and 79.2% （42/53 ） respectively, while 73.1% （ 19/26）,84.8 % （39/46） and 44.4% （8/18） for severe stenosis. The diagnostic accuracy of mild and severe stenosis was 89.7%（174/194） to 93.8%

关 键 词：糖尿病 动脉 血管造影术 数字减影 体层摄影术 x线计算机 磁共振血管造影术 超声检查 

分 类 号：R587.2[医药卫生—内分泌]