双源64排螺旋CT血管成像对下肢动脉狭窄及闭塞性病变的诊断价值

摘要

目的：通过双源64排螺旋CT血管成像（CTA）与数字减影血管造影（DSA）进行比较，探讨双源64排螺旋CTA对下肢动脉狭窄及闭塞性病变的诊断价值。方法采用德国西门子公司生产的双源64排螺旋CT对30例临床怀疑下肢动脉狭窄及闭塞性病变的患者进行双下肢动脉血管成像检查，扫描范围自腹主动脉下段至足底，扫描层厚0．75 mm，管电压120 kV，管电流250 mAs，将原始图像送入工作站进行图像后处理，主要包括容积再现（VR）、最大密度摄影（MIP）、多平面重建（MPR）、曲面重建（CPR），并结合原始图像进行分析，所有患者1周后行DSA检查，以DSA作为参考标准，对诊断一致性、敏感性、特异性和狭窄部位的检出准确率进行计算。结果在720个动脉节段中，700个节段在CTA和DSA均可以显示，以DSA作为诊断标准，双源64排螺旋CTA诊断下肢动脉闭塞的敏感性、特异性、准确性分别为99.3％、97．8％、97．8％；对于显示中度以上的狭窄，双源64排螺旋CTA的敏感性、特异性、准确性分别为99．7％、97．6％、95．6％；双源64排螺旋CTA在诊断下肢动脉狭窄及闭塞性病变与DSA结果一致性好（kappa值＝0．937）。结论双源64排螺旋CTA可以作为下肢动脉狭窄及闭塞性病变的首选检查手段，对临床具有重要的指导价值。%Objective To explore the diagnostic value of lower extremity artery narrow and occlusive disease by dual-source 64-row spiral CTA image and digital subtraction angiography (DSA). Methods By the dual-source 64-row helical CT produced by the German Siemens company, 30 cases of clinical suspected of lower extremity artery narrow and occlusive underwent the double lower extremity artery imaging with scanning ranging from lower abdomi-nal aorta to foot, scanning layer thickness of 0.75 mm, tube voltage 120 kV, tube current 250 mAs, then the original images were sent to the image post-processing work station for post-processing, mainly including VR, MIP and MPR, CPR, and analyze the images combined with the original image. All patients underwent DSA examination one week later, and based on DSA as the reference standard, consistency, sensitivity and specificity of the diagnosis and narrow part of the detection accuracy were calculated. Results Of 720 arterial segments, 700 segments could be displayed by CTA and DSA. Based on DSA as diagnostic criteria, the sensitivity, specificity and accuracy of dual- source 64-row spiral CTA in the diagnosis of lower extremity artery occlusion were 99.3%, 97.8%and 97.8%respectively; As for showing moderate above narrow, the sensitivity, specificity and accuracy of the double source 64 rows spiral CTA were 99.7%, 97.6%and 95.6%respectively. Dual-source 64-row spiral CTA in the diagnosis of lower extremity artery narrow and occlusive disease were consistent with DSA results (kappa=0.937). Conclusion Dual-source 64-row spi-ral CTA can serve as the first choice for the lower extremity artery narrow and occlusive disease, providing an impor-tant guidance for clinical value.