【摘要】 目的探究数字减影血管造影(DSA)、CT血管造影(CTA)及彩色多普勒超声(CDUS)在颈动脉内膜剥脱术(CEA)中的应用价值。方法 2015年6月—2018年5月我院及合作医院经DSA确诊颈动脉狭窄程度为50%～99%的92例狭窄患者,均行CEA治疗,术前、术后行DSA、CTA、CDUS检查,记录检查情况及不良反应。评估术前CTA、CDUS检查重度颈内动脉狭窄的准确性、灵敏度、特异度,斑块、溃疡显示情况,以及术前、术后相关指标的差异。结果 DSA完成检查的时间较长,CTA、CDUS完成检查的时间短;术前、术后DSA、CTA检查注射造影剂后分别累计12例、6例出现不良反应。DSA检查显示重度狭窄66例(71.74%)、中度狭窄26例(28.26%),以此为标准,CTA、CDUS检查重度颈内动脉狭窄的准确性、灵敏度及特异度均较高,且二者诊断重度颈内动脉狭窄的Kappa值分别为0.81、0.75,与DSA检查的一致性高。DSA能显示血管腔狭窄、充盈缺损、溃疡情况,CTA还可显示血管管壁钙化、斑块情况,CDUS则可显示钙化、斑块及血流情况。术后检查显示斑块、溃疡均基本消退,血流速度趋于正常。与术前比较,术后CTA检查显示狭窄远端直径、最小残余直径显著增大,术后CDUS检查显示狭窄处的收缩期峰值流速(PSV)与舒张期末流速(EDV)显著减小(P<0.05)。结论 CTA、CDUS术前诊断颈内动脉狭窄程度与DSA的一致性高,三种检查方式在血管管壁钙化、斑块、溃疡、血流等显示方面各有特点,可联合应用于CEA的术前术后评估。更多还原

【Abstract】 Objective To explore the value of digital subtraction angiography(DSA),CT angiography(CTA)and color Doppler ultrasound(CDUS)in carotid endarterectomy(CEA).Methods The clinical data of 92 patients with 50%—99%of carotid arterystenosis diagnosed by DSA in author′s hospital and cooperation hospital from June 2015 to May 2018 were studied.All the patients were treated by CEA.And DSA,CTA and CDUS were performed before and after operation.The situation of examinations and adverse reactions were recorded.The accuracy,sensitivity and specificity of preoperative CTA and CDUS in evaluating the severe internal carotid artery stenosis were calculated.The display of plaques and ulcer,and differences of related indexes before and after operation were compared.Results The examination time of DSA was longer than that of CTA and CDUS for the patients,respectively.There were 12 cases and 6 cases of adverse reactions after injection of contrast agents in DSA and CTA,respectively.DSA showed severe stenosis in 66 cases(71.74%)and moderate stenosis in 26 cases(28.26%).The accuracy,sensitivity and specificity of CTA and CDUS in evaluating the severe internal carotid artery stenosis were high,and the Kappa values were 0.81 and 0.75 with high consistency with results of DSA,respectively.DSA could show the condition of stenosis,filling defect and ulcer of the vascular cavity.CTA also could show calcification of vascular wall and plaques,while CDUS could show calcification,plaques and blood flow.Postoperative examination showed that plaque and ulcer basically subsided and blood flow velocity was normal.CTA showed that the distal diameter of stenosis and the minimum residual diameter increased significantly after operation,while CDUS showed that the peak systolic flow velocity(PSV)and the end diastolic velocity(EDV)decreased significantly after operation(P<0.05).ConclusionCTA and CDUS are consistent with DSA in the diagnosis of internal carotid artery stenosis before operation.The three methods have their own characteristics in displaying vascular wall calcification,plaque,ulcer and blood flow.They can be used for evaluation before and after CEA.更多还原