【作者】 张磊；

【导师】 陈静静；

【作者基本信息】 青岛大学 ， 影像医学与核医学（影像医学）， 2016， 硕士

【摘要】 目的:把数字减影血管造影(DSA)检查作为参照标准,评价128层螺旋CT血管造影(CTA)诊断主动脉弓以上动脉狭窄及伴发动脉瘤的可靠性,探讨CT血管造影对缺血性脑血管病的诊断价值和存在的不足。方法:搜集我院神经内科自2014年2月至2015年4月临床怀疑有主动脉弓以上动脉狭窄性病变的患者44例,其中男29例、女15例。所有患者均行主动脉弓以上螺旋CT血管造影检查,并在十天内行DSA检查。CTA检查采用西门子公司128层螺旋CT机扫描,利用工作站进行三维重建来分析动脉血管情况,由两位高年资影像科医生采用双盲法对动脉血管的狭窄程度进行评价。图像后处理方法有:容积显示(VR)、多平面重建(MPR)、最大密度投影(MIP)、曲面重组(CPR)、表面阴影显示(SSD)。CTA将粥样硬化斑块分为钙化斑块、混合斑块和易损斑块。把DSA检查结果作为金标准,对比动脉血管的CTA与DSA检查结果,对颅内外动脉血管狭窄和伴发动脉瘤进行统计学分析,分析CTA诊断动脉狭窄的敏感度、特异度、阳性预测值和阴性预测值。结果:44例968段血管CTA和DSA诊断符合数为935(96.5%),128层螺旋CT血管造影诊断主动脉弓以上动脉狭窄的总的敏感度93.6%,特异度为99.3%,阳性预测值为97.4%,阴性预测值为98.3%,一致性检验Kappa值为0.9172;CTA显示38个钙化斑块、41个混合斑块和76个易损斑块;CTA诊断伴发动脉瘤的敏感度和特异度均为100%。结论:128层螺旋CT血管造影(CTA)作为一种无创或微创性检查方法,在诊断头颈部动脉狭窄和伴发动脉瘤方面具有较高的敏感度和特异度,且能清晰显示狭窄血管的粥样硬化斑块,评估斑块性质。CTA可在一定程度上代替DSA用于主动脉弓以上动脉狭窄的术前诊断和术后效果评价。更多还原

【Abstract】 Objective:Compared with digital subtract angiography results,evaluation of the reliability of the supra-aortic arteries stenosal degree and complicated aneurysms with 128-silce spiral computed tomography angiography. We evaluate the clinical valve of CTA in the diagnosis and limitation of ischemic cerebrovascular disease.Methods:Compile 44(29male,15female)borderline cases with supra-aortic arteries stenosal between February 2014 and April 2015 in department of internal medicine of our hospital,whith had undergone supra-aortic arteries computed tomography angiography examination and digital subtract angiography examination within ten days.CTA was performed on a Siemens 128-slice spiral CT scan machine.The image post-processing techniques were used to detect and analyze the vascular stenosis.Two senior radiologists to evaluate the degree of stenosis of arterial blood vessels in a blind ways.Common image post-processing method: VR、MPR、CPR 、MIP、SSD and others.The atherosclerotic plaques were grouped as calcified plaque、mixed plaque and vulnerable plaque on CTA images.With the results of DSA as the gold standard to compare the results of CTA with that of DSA.The internal and external vascular stenosis and complicated aneurysms were statistical analysis.The sensitivity,specifility,positive predictive value,negative predictive value of CTA were analysed.compared with DSA.Results:The CTA readings correlated with DSA findings in 935 vessels(96.5 %),Sensitivity of 128-sile CTA in diagnosis supra-aortic arteries is 93.6%, specificity is 99.3%,PPV is 97.4%, NPV is 98.3%. Consistency test of the Kappa is 0.9172. 38 calcified plaques、41 mixed plaques and 76 vulnerable plaques were detected on CTA.The sensitivity and specificity of CTA in the diagnosis of intracranial aneurysm were 100%.Conclusion: 128-silce spiral CTA is a noninvasive or minimally invasive inspection,which has a high sensitivity and specificity in the diagnosis of supra-aortic artery stenosis and aneurysm.CTA can also clearly observe and evaluate the properties of atherosclerotic plaque.To some extent,CTA replaces DSA can be used for preoperative diagnisis 、 post-operative evaluation and epidemiological investigation of supra-aortic arteries stenosis disease.更多还原