颈动脉彩超、CTA与DSA评估颈动脉病变准确性的对比研究

发布时间：2018-01-13 17:44

本文关键词：颈动脉彩超、CTA与DSA评估颈动脉病变准确性的对比研究　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨彩色多普勒超声(color doppler sonography,CDS)、CT血管成像技术(computed tomography angiography,CTA)及数字减影血管造影(digital subtraction angiography,DSA)技术在检测颈动脉病变中的临床应用价值。材料与方法：收集313名怀疑有颈动脉病变并完成脑DSA检查患者的临床资料,部分完成颈动脉彩超及/或颈动脉CTA检查；评估颈动脉彩超、CTA、彩超与CTA联合检查在检测颈动脉狭窄及斑块中的灵敏度、特异度、准确度、约登指数、阳性似然比,阴性似然比；采用配对卡方检验、多组等级计数资料秩和检验及受试者工作特征曲线(receiver operating characteristic, ROC曲线)分析评价三种方法的差异性(P0.05统计学有意义)。结果：1.以DSA检出颈动脉狭窄为参考标准,检出颈动脉狭窄病变的灵敏度：彩超71.9%,CTA82.6%,彩超联合CTA89.1%；特异度：彩超79.7%,CTA84.9%,彩超联CTA 77.6%；准确度：彩超75.3%,CTA83.4%,彩超联合CTA 86.2%；漏诊率：彩超28.1%,CTA 17.4%,彩超联合CTA 10.9%；误诊率：彩超20.3%,CTA15.1%,彩超联合CTA22.4%,约登指数：彩超0.516,CTA0.675,彩超联合CTA0.667；阳性似然比：彩超3.5419,CTA5.4702,彩超联合CTA 3.9777；阴性似然比：彩超0.3526,CTA0.2049,彩超联合CTA0.1405;χ2:彩超78.746,CTA 90.199,彩超联合CTA81.829；K：彩超：0.508,CTA0.648,彩超联合CTA0.645； ROC曲线下面积：彩超0.758,CTA 0.838,彩超联合CTA 0.833；AUC分析提示与DSA相比,彩超(P=0.027)、CTA(P=0.041)差异有统计学意义,彩超联合CTA检查与DSA比较差异无统计学意义(P=0.442)。2.以颈动脉彩超检出斑块为参考标准,检出颈动脉斑块的灵敏度：CTA90.4%,DSA71.1%;特异度：CTA96.3%,DSA 98.5%；准确度：CTA92.9%,DSA 77.3%；漏诊率：CTA9.6%,DSA 28.9%；误诊率：CTA3.7%,DSA 1.5%；约登指数：CTA0.867,DSA0.696；阳性似然比：CTA 24.4324,DSA47.4:阴性似然比：CTA0.0997,DSA0.2934；χ2:CTA144.34,DsA103.22；P值：CTA0.057, DSA0.000；K:CTA0.855,DSA 0.519:ROC曲线下面积：CTA0.925, DSA0.747。AUC分析提示CTA与颈动脉彩超相比,差异无统计学意义(P=0.057),DSA与颈动脉彩超比较有显著统计学差异(P0.01)。结论：在评估颈动脉狭窄的非侵入性检查方法中,彩超联合CTA检查是较准确的方法,略优于单一CTA检查(86.2%vs83.4%),远远优于单一颈动脉彩超检查(86.2%vs75.3%)。与DSA比较,彩超一致性中等,彩超联合CTA一致性较高,两者联合检查可早期筛查颈动脉狭窄病变。在评估颈动脉斑块性质的方法中,CTA检查的准确性远远优于DSA(92.9%vs77.3%)。CTA与彩超比较,检查结果的一致性较好。CTA可作为评估颈部血管病变的重要方法。
[Abstract]:Objective: To investigate the effect of color Doppler ultrasound (color Doppler, sonography, CDS), CT angiography (computed tomography angiography, CTA) and digital subtraction angiography (digital subtraction angiography DSA) technology in clinical detection of carotid artery disease in the application value. Materials and methods: collected 313 suspected carotid artery disease and complete the clinical data of patients with cerebral DSA examination, part of the completion of carotid artery ultrasonography and / or CTA examination of carotid artery; evaluation of carotid artery ultrasonography, CTA, sensitivity, ultrasound combined with CTA examination in detection of carotid artery stenosis and plaque specificity, accuracy, Youden index, positive likelihood ratio, and negative likelihood ratio; paired card square test, multiple level count data, rank sum test and receiver operating characteristic curve (receiver operating characteristic, ROC curve) analysis of differences of the three evaluation methods of the statistics (P0.05 Meaningful). Results: 1. carotid artery stenosis as the reference standard for DSA detection, the sensitivity of the detection of carotid stenosis: 71.9% CTA82.6%, color Doppler ultrasound, color Doppler ultrasound combined with CTA89.1%; specificity: Color Doppler 79.7%, CTA84.9%, CTA 77.6% color Doppler ultrasound; accuracy: 75.3% CTA83.4%, color Doppler ultrasound, color Doppler ultrasound combined with CTA 86.2%; the rate of misdiagnosis. Ultrasound 28.1%, CTA 17.4%, CTA 10.9% color Doppler ultrasound combined with color Doppler ultrasound; misdiagnosis rate of 20.3%, CTA15.1%, CTA22.4% color Doppler ultrasound combined with color Doppler ultrasound in 0.516, Youden index: CTA0.675, CTA0.667, color Doppler ultrasound combined with positive likelihood ratio: 3.5419; color Doppler ultrasound, color Doppler ultrasound combined with CTA5.4702, CTA 3.9777; negative likelihood ratio: 0.3526 CTA0.2049, color Doppler ultrasound, color Doppler ultrasound combined with CTA0.1405 x 2:; ultrasound 78.746, CTA 90.199, CTA81.829 color Doppler ultrasound combined with color Doppler ultrasound: 0.508; K: CTA0.648, CTA0.645, color Doppler ultrasound combined with color Doppler ultrasound; the area under ROC curve: 0.758, CTA 0.838, color ultrasound combined with CTA AUC analysis showed that 0.833; Compared with DSA, color Doppler ultrasound (P=0.027), CTA (P=0.041) with statistically significant difference, no statistical significance of color Doppler ultrasound combined with CTA examination and the difference of DSA (P=0.442).2. with carotid artery ultrasound detected plaque as the reference standard, the sensitivity of carotid artery plaque: CTA90.4%, DSA71.1%; specificity: CTA96.3% DSA, 98.5%; accurate degree: CTA92.9%, DSA 77.3%; the rate of misdiagnosis: CTA9.6%, DSA 28.9%; the misdiagnosis rate: CTA3.7%, DSA 1.5%; CTA0.867, DSA0.696; Youden index: positive likelihood ratio: CTA 24.4324, DSA47.4:, CTA0.0997, negative likelihood ratio DSA0.2934; X 2:CTA144.34, DsA103.22; P value: CTA0.057, DSA0.000; K:CTA0.855, DSA area 0.519:ROC under the curve: CTA0.925, DSA0.747.AUC and CTA analysis showed that the carotid artery color Doppler ultrasound compared with no significant difference (P=0.057), DSA and carotid ultrasonography compared with significant statistical difference (P0.01). Conclusion: in the evaluation of carotid Arterial stenosis and non invasive method, color Doppler ultrasonography combined with CTA examination method is more accurate, slightly better than the single CTA (86.2%vs83.4%), far better than the single carotid artery ultrasonography (86.2%vs75.3%). Compared with DSA, color consistency, high color Doppler ultrasound combined with CTA consistency, combined examination of early screening of carotid artery in the evaluation method. The stenosis of carotid artery atherosclerotic plaque, accuracy of CTA examination is far better than that of DSA (92.9%vs77.3%).CTA and color Doppler ultrasound, consistent.CTA results can be used as an important method to evaluate the neck vascular lesions.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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