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目的通过比较MDCTA与DSA对颈动脉病变的诊断差异以期评价MDCTA的临床应用价值。材料与方法(1)搜集经颈动脉DSA和MDCTA检查的临床病例19例。(2)随机选择实验动物猪10头,通过导丝损伤和外科手术建立猪颈动脉血管腔内、腔外狭窄模型,行DSA和MDCTA造影对照。根据国外采用的分类方法并结合血管外科手术与否的判断标准,以50%为界将狭窄程度分成两组,分别评价MDCTA诊断价值。数据分析采用诊断实验评价。结果DSA检查正常13例中,MDCTA正常12例,1例误诊为轻度狭窄。狭窄血管56处,MDCTA漏诊3处。MDCTA对颈动脉狭窄程度的判断与DSA有很好的相关性,敏感性为94.6%,特异性为92.3%,准确性94.2%,阳性预测值为98.2%,阴性预测值为80.0%。其中,狭窄在50%以下者37处,CTA漏诊3处,敏感性为91.9%;狭窄超过50%者19处,MDCTA无漏诊,敏感性为100%。MDCTA显示病灶不规则内表面4例,斑块溃疡3例,均经病理标本证实,而DSA显示不规则2例,溃疡1例。结论颈动脉MDCTA可以取代诊断用途的DSA。在显示血管狭窄的形态、斑块表面不规则、斑块溃疡以及重度狭窄后血管等方面,大范围颈动脉MDCTA更有优势。
Objective To compare the diagnosis of carotid artery lesions by MDCTA and DSA in order to evaluate the clinical value of MDCTA. Materials and Methods (1) To collect the clinical cases of carotid DSA and MDCTA examination in 19 cases. (2) Ten pigs were randomly selected, and the endovascular and extracavitary stenosis models of pig carotid artery were established by means of guidewire injury and surgery. DSA and MDCTA contrast were performed. According to the classification method adopted abroad and the standard of vascular surgery or not, the stenosis degree was divided into two groups by 50%, and the diagnostic value of MDCTA was evaluated respectively. Data analysis using diagnostic test evaluation. Results Among the 13 cases with normal DSA, 12 cases had normal MDCTA and 1 case was misdiagnosed as mild stenosis. Fifty-six of the stenotic vessels were missed by MDCTA. The diagnosis of carotid artery stenosis by MDCTA had good correlation with DSA. The sensitivity was 94.6%, the specificity was 92.3%, the accuracy was 94.2%, the positive predictive value was 98.2% and the negative predictive value was 80.0%. Among them, 37 were less than 50%, 3 were missed by CTA, and the sensitivity was 91.9%. In those with more than 50% stenosis, there were 19 without any misdiagnosis, and the sensitivity was 100%. MDCTA showed irregular inner surface of the lesions in 4 cases, 3 cases of plaque ulcers, confirmed by pathological specimens, and DSA showed irregular 2 cases, 1 case of ulcer. Conclusion Carotid artery MDCTA can replace diagnostic use of DSA. A wide range of carotid artery MDCTAs are more advantageous in terms of patterns of vascular stenosis, plaque surface irregularities, plaque ulceration, and blood vessels behind severe stenosis.