16层螺旋CT血管造影对颈内动脉粥样硬化狭窄性病变诊断的应用研究
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摘要
目的:分析16层螺旋CT血管造影(16-MSCTA)颈动脉成像技术的影像学特征,探讨16-MSCTA在颈内动脉粥样硬化狭窄性病变的临床应用价值。
方法:收集92例缺血性脑血管病患者行颅颈部16-MSCTA检查(其中包括6例颅颈部动脉支架术后随访患者),对颈动脉成像重建按1-3级评价图像质量;统计斑块类型、分布及钙化情况;对其中拟诊为前循环缺血卒中的55例患者1周内先后进行16-MSCTA及数字减影血管造影(DSA)检查,以DSA为标准,评价16-MSCTA对颅外段颈内动脉狭窄诊断的准确性、敏感性、特异性、阳性预测值、阴性预测值。
结果:16-MSCTA对颈动脉成像重建后图像的总体可评价率为91.8%,颈动脉起始段、颅外、颅内段可评价血管显示率分别为92.9%、97.8%、84.7%。16-MSCTA与DSA对本组中55例共计110支颅外段颈内脉检查结果进行对比,两者对颅外段颈内动脉狭窄程度分级判断的一致性为90.9%,kappa值0.875(p <0. 001),16-MSCTA对颅外段颈内动脉各级狭窄诊断的灵敏性、特异性、阳性预测值、阴性预测值,在轻度狭窄为:88.89%、93.33%、84.21%、95.45%;中度狭窄为:95.83%、95.45%、88.46%、98.43%;重度狭窄为:100%、98.90%、93.75%、100%;闭塞为:100%、100%、100%、100%。92例患者中,16-MSCTA共检出74例患者175处斑块。其中,主动脉弓11处、颈总动脉33处、颈动脉分叉部92处、颈内动脉25处、颈外动脉14处。颈动脉分叉部斑块发生的概率及钙化的概率均最高。6例颅颈部动脉支架随访患者,16-MSCTA均能较好的显示支架腔内情况,判断腔内的通畅性。
结论:1.16-MSCTA对颈动脉总体成像质量较高,但各部位有区别,其中对于颅外段的成像质量相对较好。2.在颅外段颈内动脉狭窄程度分级的判定中,16-MSCTA与DSA相比有很高的一致性,并且其诊断效能随着狭窄程度的加重而增加,可作为颅外段颈内动脉狭窄的筛查手段。3.16-MSCTA检查可较大范围地发现粥样斑块的分布并可对其进行性质判定;颈动脉不同区域粥样斑块的分布和钙化差异存在显著性意义,局限于分叉段的颈动脉检查可能漏诊高风险斑块。4.16-MSCTA能对颅外动脉支架术后腔内通畅性进行初步评估,为支架术后随访提供了新的思路。
Objective: To analyze 16 segments of multislice computed tomography angiography (16-MSCTA), to explore the clinical value of 16-MSCTA in atherosclerotic sclerosis lesion of internal carotid artery.
Methods: Collected from 92 cases of ischemic cerebrovascular disease who underwent 16-MSCTA examination (included 6 cases of cranio-cervical artery stent follow-up patients), imaging of carotid artery reconstruction by 1-3 grade image quality evaluation; Statistics plaque type, distribution and calcification of the situation, in 55 cases, patients who were diagnosed with anterior circulation ischemic attack within 1 week underwent 16-MSCTA and digital subtraction angiography (DSA) examination, in which DSA as a standard measurement, to assess 16-MSCTA diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of extra-cranial internal carotid artery stenosis.
Results: After carotid artery image reconstruction formed with 16-MSCTA, 91.8 % appraisal rate for overall images, initial segment of carotid artery, extra-cranium, and intra-cranium segments’blood vessel display rate is 92.9%, 97.8%, 84.7% respectively. By comparing 16-MSCTA and DSA test results of 55 cases of a total 110 extra-cranial internal carotid pulse within this group, both extra-cranial carotid artery stenosis degree judgement uniformity are 90.9%, kappa 0.875(p<0.001), the 16-MSCTA diagnosis sensitivity, specificity, positive predictive value, negative predictive value, and mild degree stenosis in all levels of extra-cranial internal carotid artery stenosis are 88.89%、93.33%、84.21%、95.45%;medium:95.83%、95.45%、88.46%、98.43%;severe degree:100%、98.90%、93.75%、100%, occlusion: 100%,100%,100%,100%. Among 92 cases, 74 cases of patients, who had done 16-MSCTA, were detected with 175 plaques, of these, 11 in aortic arch, 33 in common carotid artery, 92 in the bifurcation of carotid artery, 25 in internal carotid artery, and 14 in external carotid artery. The probability of artery plaque and calcification occurance in the bifurcation of carotid artery is the highest. 6 cases of cranio-cervical artery stent follow-up patients, 16-MSCTA is better in showing condition of the stent, to determine the patency of the cavity.
Conclusions: 1. 16-MSCTA to Carotid Artery main body’s image quality is higher, but each part is different, in between compare to the extra-cranial part’s image quality is better. 2. At the determination of extra-cranial Internal Carotid Artery stenosis degree, comparing between 16-MSCTA and DSA, not only the consistency is very high, but also the efficiency in diagnosing the severity and the increase rate of the stenosis, so it can be used at extra-cranial internal carotid artery stenosis condition. 3. 16-MSCTA examination can find the distribution of the atherosclerotic plaque in bigger scope, and also in determination of progressing substances, from my observation: the difference between Carotid Artery’s atherosclerotic plaque distribution site and calcification remain as a prominent significance, limited until carotid artery bifurcation examination can be missed diagnosis as high risk plaque. 4. 16-MSCTA can be used for the initial assessment of the intracavity post extra-cranial Artery stent operation, as to provide a new route for post stent operation follow-up.
方法:收集92例缺血性脑血管病患者行颅颈部16-MSCTA检查(其中包括6例颅颈部动脉支架术后随访患者),对颈动脉成像重建按1-3级评价图像质量;统计斑块类型、分布及钙化情况;对其中拟诊为前循环缺血卒中的55例患者1周内先后进行16-MSCTA及数字减影血管造影(DSA)检查,以DSA为标准,评价16-MSCTA对颅外段颈内动脉狭窄诊断的准确性、敏感性、特异性、阳性预测值、阴性预测值。
结果:16-MSCTA对颈动脉成像重建后图像的总体可评价率为91.8%,颈动脉起始段、颅外、颅内段可评价血管显示率分别为92.9%、97.8%、84.7%。16-MSCTA与DSA对本组中55例共计110支颅外段颈内脉检查结果进行对比,两者对颅外段颈内动脉狭窄程度分级判断的一致性为90.9%,kappa值0.875(p <0. 001),16-MSCTA对颅外段颈内动脉各级狭窄诊断的灵敏性、特异性、阳性预测值、阴性预测值,在轻度狭窄为:88.89%、93.33%、84.21%、95.45%;中度狭窄为:95.83%、95.45%、88.46%、98.43%;重度狭窄为:100%、98.90%、93.75%、100%;闭塞为:100%、100%、100%、100%。92例患者中,16-MSCTA共检出74例患者175处斑块。其中,主动脉弓11处、颈总动脉33处、颈动脉分叉部92处、颈内动脉25处、颈外动脉14处。颈动脉分叉部斑块发生的概率及钙化的概率均最高。6例颅颈部动脉支架随访患者,16-MSCTA均能较好的显示支架腔内情况,判断腔内的通畅性。
结论:1.16-MSCTA对颈动脉总体成像质量较高,但各部位有区别,其中对于颅外段的成像质量相对较好。2.在颅外段颈内动脉狭窄程度分级的判定中,16-MSCTA与DSA相比有很高的一致性,并且其诊断效能随着狭窄程度的加重而增加,可作为颅外段颈内动脉狭窄的筛查手段。3.16-MSCTA检查可较大范围地发现粥样斑块的分布并可对其进行性质判定;颈动脉不同区域粥样斑块的分布和钙化差异存在显著性意义,局限于分叉段的颈动脉检查可能漏诊高风险斑块。4.16-MSCTA能对颅外动脉支架术后腔内通畅性进行初步评估,为支架术后随访提供了新的思路。
Objective: To analyze 16 segments of multislice computed tomography angiography (16-MSCTA), to explore the clinical value of 16-MSCTA in atherosclerotic sclerosis lesion of internal carotid artery.
Methods: Collected from 92 cases of ischemic cerebrovascular disease who underwent 16-MSCTA examination (included 6 cases of cranio-cervical artery stent follow-up patients), imaging of carotid artery reconstruction by 1-3 grade image quality evaluation; Statistics plaque type, distribution and calcification of the situation, in 55 cases, patients who were diagnosed with anterior circulation ischemic attack within 1 week underwent 16-MSCTA and digital subtraction angiography (DSA) examination, in which DSA as a standard measurement, to assess 16-MSCTA diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of extra-cranial internal carotid artery stenosis.
Results: After carotid artery image reconstruction formed with 16-MSCTA, 91.8 % appraisal rate for overall images, initial segment of carotid artery, extra-cranium, and intra-cranium segments’blood vessel display rate is 92.9%, 97.8%, 84.7% respectively. By comparing 16-MSCTA and DSA test results of 55 cases of a total 110 extra-cranial internal carotid pulse within this group, both extra-cranial carotid artery stenosis degree judgement uniformity are 90.9%, kappa 0.875(p<0.001), the 16-MSCTA diagnosis sensitivity, specificity, positive predictive value, negative predictive value, and mild degree stenosis in all levels of extra-cranial internal carotid artery stenosis are 88.89%、93.33%、84.21%、95.45%;medium:95.83%、95.45%、88.46%、98.43%;severe degree:100%、98.90%、93.75%、100%, occlusion: 100%,100%,100%,100%. Among 92 cases, 74 cases of patients, who had done 16-MSCTA, were detected with 175 plaques, of these, 11 in aortic arch, 33 in common carotid artery, 92 in the bifurcation of carotid artery, 25 in internal carotid artery, and 14 in external carotid artery. The probability of artery plaque and calcification occurance in the bifurcation of carotid artery is the highest. 6 cases of cranio-cervical artery stent follow-up patients, 16-MSCTA is better in showing condition of the stent, to determine the patency of the cavity.
Conclusions: 1. 16-MSCTA to Carotid Artery main body’s image quality is higher, but each part is different, in between compare to the extra-cranial part’s image quality is better. 2. At the determination of extra-cranial Internal Carotid Artery stenosis degree, comparing between 16-MSCTA and DSA, not only the consistency is very high, but also the efficiency in diagnosing the severity and the increase rate of the stenosis, so it can be used at extra-cranial internal carotid artery stenosis condition. 3. 16-MSCTA examination can find the distribution of the atherosclerotic plaque in bigger scope, and also in determination of progressing substances, from my observation: the difference between Carotid Artery’s atherosclerotic plaque distribution site and calcification remain as a prominent significance, limited until carotid artery bifurcation examination can be missed diagnosis as high risk plaque. 4. 16-MSCTA can be used for the initial assessment of the intracavity post extra-cranial Artery stent operation, as to provide a new route for post stent operation follow-up.
引文
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