计算机断层扫描血管造影在颈动脉狭窄和颈动脉粥样硬化斑块形态评估中的应用价值  

Application value of computer tomography angiography in the evaluation of carotid artery stenosis and carotid atherosclerotic plaque morphology

作　　者：申太忠 姚志敏 李宝 谢灵争 Shen Taizhong;Yao Zhimin;Li Bao;Xie Lingzheng(Department of Imaging,Aviation General Hospital,Beijing 100012,China;Department of Vascular Surgery,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院影像科,北京100012 [2]航空总医院血管外科,北京100012

出　　处：《血管与腔内血管外科杂志》2022年第9期1067-1070,共4页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨计算机断层扫描血管造影(CTA)在颈动脉狭窄和颈动脉粥样硬化斑块形态评估中的应用价值。方法收集2020年7月至2021年7月于航空总医院80例经初步检查拟诊为颈动脉狭窄患者的临床资料。所有患者均接受CTA、数字减影血管造影(DSA)检查。以DSA检查结果为诊断颈动脉狭窄及其严重程度的金标准,分析CTA检查对颈动脉狭窄的诊断效能(灵敏度、特异度、准确度),并分析其与DSA检查结果之间的一致性。结果在80例经初步检查拟诊为颈动脉狭窄的患者中,共检查316段血管节段,DSA检查结果证实,发生颈动脉狭窄患者67例,共112段血管节段;未发生颈动脉狭窄患者13例,共204段血管节段。轻度、中度、重度狭窄及闭塞患者中检出的血管节段数量分别为34段、50段、20段、8段。CTA检查结果显示,发生颈动脉狭窄和未发生颈动脉狭窄患者分别为65例、15例。CTA诊断颈动脉狭窄的准确度、灵敏度、特异度分别为96.25%(77/80)、97.01%(65/67)、92.31%(12/13)。CTA与DSA检查对颈动脉狭窄及其严重程度的诊断结果高度一致(Kappa=0.866、0.914,P<0.01)。DSA检查结果显示,112段血管节段中,8段血管节段发生闭塞,其余104段发生狭窄的颈动脉中均存在粥样硬化斑块。CTA检查结果显示,在颈动脉斑块中,光滑斑块占比最高(65.38%),其次为不规则斑块(25.00%)和溃状斑块(9.62%)。结论CTA对颈动脉狭窄的诊断效能较高,不但能够准确了解狭窄程度,还能明确斑块形态,进而为临床提供更为详实的参考依据,应用价值较高。Objective To explore the application value of computer tomography angiography(CTA)in the evaluation of carotid artery stenosis and carotid atherosclerotic plaque morphology.Method The clinical data of 80 patients with suspected carotid artery stenosis by initial diagnosis in Aviation General Hospital from July 2020 to July 2021 were collected.All patients received CTA and digital subtraction angiography(DSA).By using DSA results as the gold standard for diagnosing carotid stenosis and severity,the diagnostic efficacy(sensitivity,specificity,accuracy)of CTA in carotid stenosis was analyzed,and the consistency between CTA and DSA was analyzed.Result DSA confirmed that there were 316 vascular segments in 80 patients with suspected carotid artery stenosis,including 67 patients with carotid artery stenosis and 112 vascular segments.No carotid stenosis occurred in 13 patients,with 204 vascular segments.The number of segments detected in patients with mild,moderate and severe stenosis and occlusion was 34,50,20 and 8,respectively.CTA showed that 65 patients had carotid stenosis and 15 patients had no carotid stenosis.The accuracy,sensitivity and specificity of CTA in diagnosing carotid stenosis were 96.25%(77/80),97.01%(65/67)and 92.31%(12/13),respectively.The diagnostic results of CTA and DSA for carotid stenosis and its severity were highly consistent(Kappa=0.866,0.914,P<0.01).DSA results showed that among 112 segments,8 segments were occluded,and 104segments were stenotic carotid arteries with atherosclerotic plaques.CTA results showed that among carotid plaques,smooth plaques accounted for the highest percentage(65.38%),followed by irregular(25.00%)and ulcerated plaques(9.62%).Conclusion CTA has high diagnostic efficacy in carotid artery stenosis,which can not only accurately detect the degree of stenosis,but also determine the shape of plaque,thus providing a more detailed reference for clinical use,with high application value.

关 键 词：计算机断层扫描血管造影 颈动脉狭窄 颈动脉粥样硬化 斑块形态 

分 类 号：R543.4[医药卫生—心血管疾病]