CTA、CE-MRA、DUS对糖尿病下肢动脉病变的诊断价值对比研究  

Comparison of diagnostic value of CTA, CE-MRA and DUS in diabetic lower extremity arterial disease

作　　者：李佳 王俊 LI Jia;WANG Jun(Department of Radiology,Yichang Second People's Hospital,Yichang 443000,P.R.China;Department of Radiology,Affiliated Hospital of Hubei Three Gorges Polytechnic,Yichang 443000,P.R.China)

机构地区：[1]湖北省宜昌市第二人民医院放射科,湖北宜昌443000 [2]湖北三峡职业技术学院附属医院放射科,湖北宜昌443000

出　　处：《医学影像学杂志》2019年第12期2131-2135,共5页Journal of Medical Imaging

摘　　要：目的比较彩色多普勒超声(DUS)、三维动态增强磁共振血管成像(CE-MRA)、CT血管造影(CTA)对糖尿病下肢动脉病变的诊断价值。方法将本院115例诊断为糖尿病引起的下肢动脉病变(下肢动脉狭窄或闭塞病变)的患者作为观察对象,均行单侧或双侧的CTA、CE-MRA、DUS影像学检查,对其临床资料及影像学资料进行回顾性分析。115例患者中(149条下肢动脉),98条下肢动脉行DUS检查,63条下肢动脉行CE-MRI检查,85例下肢动脉行CTA检查。对血管分支进行分级,其中膝上动脉为1级,膝下动脉为2级,足背动脉为3级。将DSA检查为金标准,分别计算上述DUS、CE-MRA、CTA对评估糖尿病下肢动脉病变狭窄程度的诊断价值。结果115例患者149条下肢动脉中,按照血管分支分级,其中1级:轻度狭窄79条,中度狭窄41例,重度狭窄或闭塞29条;2级:轻度狭窄51条,中度狭窄48例,重度狭窄或闭塞50条;3级:轻度狭窄98条,中度狭窄37例,重度狭窄或闭塞14条。在行DUS检查的下肢动脉病变中,1、2、3级动脉中度狭窄的灵敏度分别为91.18%、87.23%、78.57%,特异度分别为93.75%、96.08%、98.57%;3级动脉重度狭窄的灵敏度分别为75.00%、81.82%、55.56%,特异度分别为93.02%、90.91%、97.75%。在行CE-MRA检查的糖尿病下肢动脉病变中,CE-MRA诊断1、2、3级动脉中度狭窄的灵敏度分别为91.43%、98.04%、94.74%,特异度分别为89.29%、83.33%、84.00%;CE-MRA诊断1、2、3级动脉重度狭窄的灵敏度分别为90.91%、80.00%、50.00%,特异度分别为94.23%、94.74%、96.23%。在行CTA检查的糖尿病下肢动脉病变中,CTA诊断1、2、3级动脉中度狭窄的灵敏度分别为100.00%、97.56%、93.33%,特异度分别为98.31%、93.18%、95.71%;CTA诊断1、2、3级动脉重度狭窄的灵敏度分别为100.00%、94.12%、85.71%,特异度分别为97.30%、97.06%、98.72%。结论DUS、CE-MRA、CTA在诊断糖尿病下肢动脉病变方面均具有较高的准确性,其中CTA对评估患Objective To compare the diagnostic value of three imaging methods:doppler ultrasound(DUS),three-dimensional contrast enhanced magnetic resonance angiography(CE-MRA)and CT angiography(CTA),in the diagnosis of diabetic lower extremity arterial disease.Methods 115 cases of lower extremity artery disease(lower extremity artery stenosis or occlusive disease)caused by diabetes in our hospital were examined by CTA,CE-MRA and DUS,and the clinical data and imaging data were analyzed retrospectively.Of the 115 patients(149 lower extremity arteries),98 lower extremities underwent DUS examination,63 lower extremities underwent CE-MRI examination,and 85 lower extremities underwent CTA examination.The branches of the blood vessels were classified into the superior knee artery as grade 1,the inferior knee artery as grade 2,and the dorsal artery of the foot as grade 3.The diagnostic value of the three different imaging methods(DUS,CE-MRA and CTA)for assessing the degree of stenosis of diabetic lower extremity arterial disease was calculated by using the DSA(digital subtraction angiography).Results Among the 149 lower extremity arteries,115 cases were classified according to the branches of blood vessels,including grade 1:mild stenosis in 79 branches,moderate stenosis in 41 branches,severe stenosis or occlusion in 29 branches;grade 2:mild stenosis in 51 branches,moderate stenosis in 48 branches,severe stenosis or occlusion in 50 branches;grade 3:mild stenosis in 98 branches,moderate stenosis in 37 branches,severe stenosis or occlusion in 14 branches.The sensitivity of the grade 1,2,3 for moderate stenosis was 91.18%,87.23%,78.57%,and the specificity was 93.75%,96.08%,98.57%,re-spectively in the 98 branches of DUS examination of the lower extremity artery stenosis.The sensitivity of grade 1,2 and 3 for stenosis were respectively,respectively,and the specificity respectively.The sensitivity of CE-MRA in the diagnosis of moderate stenosis of the grade 1,2,and 3 arteries was 91.43%,98.04%,94.74%,and the specificity was 89.29%,83.33%

关 键 词：糖尿病 下肢动脉病变 体层摄影术 X线计算机 血管造影 三维增强磁共振血管成像 彩色多普勒超声 

分 类 号：R654.4[医药卫生—外科学] R445[医药卫生—临床医学]