评估颈内动脉颅内段血管狭窄三种影像学方法的对比分析

摘要

Objective To compare the clinical application of three imaging methods (CTA, MRA and DSA) in evaluating intracranial internal carotid artery stenosis. Methods A total of 60 patients with clinical diagnosis of transient ischemic attack or ischemic cerebral stroke, who were encountered at authors’ hospital during the period from Jan. 2011 to Feb. 2013, were enrolled in this study. All the patients underwent 64-slice CTA, MRA and DSA. The clinical data were retrospectively analyzed. The intracranial internal carotid artery (C1 - C5 segment) was divided into three groups: C1 - C3 segment, C4 segment and C5 segment. Compared with the results of DSA, which was regarded as the “gold standard”, the sensitivity, specificity and accuracy of CTA and MRA were determined. The results of CTA and MRA were statistically analyzed and compared with each other. Results The sensitivity, specificity and accuracy of CTA for C1-C3, C4 and C5 segment of intracranial internal carotid artery stenosis were 94.03%, 79.25% and 87.50%; 94.64%, 85.94%and 90.00%; 96.23%, 89.55% and 92.50%, respectively. Whereas the sensitivity, specificity and accuracy of MRA for C1 - C3, C4 and C5 segment of intracranial internal carotid artery stenosis were 89.55%, 75.47%and 83.33%;91.07%, 82.81%and 86.67%;94.34%, 85.08%and 89.17%, respectively. Statistically significant difference in detecting intracranial internal carotid artery stenosis existed between CTA and MRA. Conclusion In diagnosing intracranial internal carotid artery stenosis, CTA and MRA have higher accuracy and are well compatible with that of DSA. Compared with MRA, 64-slice CTA has more high diagnostic value and accuracy in evaluating intracranial internal carotid artery stenosis located at C4-C5 segment.(J Intervent Radiol, 2014, 23:333-336).%目的：探讨64排CTA、MRA和DSA 3种方法评估颈内动脉颅内段血管狭窄程度的临床应用价值。方法回顾性分析2011年1月-2013年2月60例临床拟诊为颈内动脉系统短暂性脑缺血发作或缺血性脑卒中并同期行64排CTA、MRA、DSA 三种检查患者的图像。将颈内动脉颅内段C1~C5段分为C1~C3段、C4段、C5段三组。以DSA检查结果为“金标准”，分别计算CTA及MRA对颈内动脉颅内段血管狭窄程度评估的灵敏度、特异度及准确率等诊断指标；比较CTA及MRA对颈内动脉颅内段血管狭窄程度的诊断效能。结果 CTA诊断颈内动脉C1~C3段病变狭窄程度的灵敏度、特异度、准确率分别为94.03%，79.25%，87.50%；C4段分别为94.64%，85.94%，90.00%；C5段分别为96.23%，89.55%，92.50%。 MRA诊断颈内动脉C1~3段病变狭窄程度的灵敏度、特异度、准确率分别为89.55%，75.47%，83.33%；C4段分别为91.07%，82.81%，86.67%；C5段分别为94.34%，85.08%，89.17%。 CTA与MRA诊断颈内动脉颅内段病变狭窄程度的准确率差异有统计学意义（P<0.05）。结论以DSA为标准，64排CTA和MRA评估颈内动脉颅内段血管狭窄程度有着较高的准确率及吻合度，且64排CTA的评估准确率优于MRA，特别是对颈内动脉C4~C5段诊断，有着较高的诊断价值。