CTA与3D CE⁃MRA对糖尿病足患者下肢动脉硬化病变的诊断价值  

Diagnostic value of CTA and 3D CE⁃MRA on lower extremity atherosclerotic lesions in patients with diabetic foot

作　　者：周莉[1] 刘芝克 董景宣 刘义杰[3] ZHOU Li;LIU Zhike;DONG Jingxuan;LIU Yijie(CT and MRI Room,Linquan County People's Hospital,Fuyang,Anhui,China,236400;Department of General Medicine,Linquan County People's Hospital,Fuyang,Anhui,China,236400;Department of Vascular Surgery,Linquan County People's Hospital,Fuyang,Anhui,China,236400)

机构地区：[1]临泉县人民医院CT、MRI室,安徽阜阳236400 [2]临泉县人民医院全科医学科,安徽阜阳236400 [3]临泉县人民医院血管外科,安徽阜阳236400

出　　处：《分子诊断与治疗杂志》2023年第7期1229-1233,共5页Journal of Molecular Diagnostics and Therapy

基　　金：安徽省自然科学基金面上项目(1908085MH215)。

摘　　要：目的探究CT血管造影(CTA)与三维增强磁共振血管造影(3D CE⁃MRA)对糖尿病足(DF)患者下肢动脉硬化病变的诊断价值。方法选取临泉县人民医院2020年7月至2022年7月120例糖尿病足患者资料,所有患者均行CTA、3D CE⁃MRA、数字减影血管造影(DSA)影像学检查。以DSA检查为金标准,比较CTA、3D CE⁃MRA与DSA对糖尿病足患者的下肢动脉硬化病变的诊断价值,分析不同检测方式对下肢各段动脉病变支数、狭窄程度分级的检出情况。结果1684段血管中,DSA检测狭窄693段,非狭窄991段;CTA检测680段狭窄,1004段非狭窄,其中漏诊61例,误诊48例,诊断敏感度为91.20%,特异度为95.15%,准确率为93.53%,kappa值为0.866;3D CE⁃MRA检测687段狭窄,997段非狭窄,其中漏诊44例,误诊38例,诊断敏感度为93.65%,特异度为96.16%,准确率为95.13%,kappa值为0.899;CTA、3D CE⁃MRA各段检出率与DSA比较均无统计学意义(χ^(2)=1.188、3.703、0.408,P>0.05);CTA诊断0~Ⅳ级的准确率分别为89.56%、92.14%、88.30%、88.67%、91.80%,总准确率为90.20%;3D CE⁃MRA诊断0~Ⅳ级的准确率分别为91.04%、92.96%、88.20%、93.79%、90.63%,总准确率为91.63%。结论CTA与3D CE⁃MRA对DF患者下肢动脉硬化病变均具有较高的诊断价值,其中3D CE⁃MRA对早期动脉血管狭窄的诊断准确性略高于CTA。Objective To explore the diagnostic value of CT angiography(CTA)and three⁃di⁃mensional contrast⁃enhanced magnetic resonance angiography(3D CE⁃MRA)on lower extremity atherosclerot⁃ic lesions in patients with diabetic foot(DF).Methods The data of 120 patients with DF in Linquan County People's Hospital from July 2020 to July 2022 were retrospectively analyzed.All patients underwent CTA,3D CE⁃MRA and digital subtraction angiography(DSA).With DSA examination as the gold standard,the diag⁃nostic value of CTA,3D CE⁃MRA and DSA on lower extremity atherosclerotic lesions in patients with DF as well as detection status of atherosclerotic lesion count in each segment of lower extremity and grading of steno⁃sis by different detection methods were compared.Results Among 1684 segments of blood vessels,DSA de⁃tected 693 stenosis segments and 991 non⁃stenosis segments and CTA detected 680 stenosis segments and 1,004 non⁃stenosis segments,and there were 61 cases of missed diagnosis and 48 cases of misdiagnosis,and the diagnostic sensitivity,specificity,accuracy rate and kappa value were 91.20%,95.15%,93.53%and 0.866.687 segments of stenosis and 997 segments of non⁃stenosis were detected by 3D CE⁃MRA,and there were 44 cases of missed diagnosis and 38 cases of misdiagnosis,and the diagnostic sensitivity,specificity,accuracy rate and kappa value were 93.65%,96.16%,95.13%and 0.899.There were 214 segments of superior genicu⁃lar artery,353 segments of inferior genicular artery and 126 segments of foot artery among 693 segments of stenosis.There was no statistical significance in the detection rate of each segment by CTA and 3D CE⁃MRA compared to DSA(χ^(2)=1.188,3.703,0.408,P>0.05).Among 1,684 segments of blood vessels,there were 334 segments of stenosis grade 0,334 segments of gradeⅠ,358 segments of gradeⅡ,297 segments of gradeⅢand 61 segments of gradeⅣ.The accuracy rates of CTA in the diagnosis of grades 0~Ⅳwere 89.56%,92.14%,88.30%,88.67%and 91.80%respectively.The accuracy rates of 3D CE⁃

关 键 词：CT血管造影 三维增强磁共振血管造影 数字减影血管造影 糖尿病足 下肢动脉硬化 动脉狭窄 

分 类 号：R587.2[医药卫生—内分泌] R543.5[医药卫生—内科学]