64排CT血管成像对下肢动脉闭塞症的评价

发布时间：2018-05-17 23:07

  本文选题：CT血管成像 + 数字减影血管造影　； 参考：《山西医科大学》2012年硕士论文

【摘要】：目的：下肢动脉闭塞症在我国发病率越来越高，而下肢动脉粥样硬化及糖尿病是其主要病因，它严重影响中老年人群的生活质量，准确的评估对于临床治疗方式的选择至关重要。下肢动脉闭塞症的影像学检查方法很多，数字减影血管造影（DSA）被认为是检查下肢动脉闭塞症的“金标准”，但它存在有创伤、有并发症风险等不足。自多层螺旋CT问世以来，由于其安全、快速、无创、准确性高等特点，CT血管成像（CTA）已广泛应用于临床。现回顾性对比分析15例下肢动脉闭塞症患者的CTA表现，全部患者2周内行DSA检查，探讨CTA对该疾病诊断价值。 方法：收集临床疑诊下肢动脉闭塞症患者15例，均行64排螺旋CTA扫描，并全部在两周内行双下肢DSA检查，将每位患者下肢血管分为22个解剖段（双侧髂总动脉、髂外动脉、髂内动脉、股动脉、股浅动脉、股深动脉、乆动脉、胫前动脉、胫腓干、胫后动脉及腓动脉)，动脉狭窄程度分为正常、轻度（1%~49%）、中度（50%~74%）、重度（75%~99%）和闭塞五个级别，并以DSA为标准进行对比，应用SPSS17．0统计分析软件，对DSA及CTA两种检查方法的结果进行处理，得到双向有序属性相同的列联表资料分析，采用Kappa一致性检验法对CTA和DSA两种独立方法的评价结果进行统计学处理得到Kappa值和P值，以“金标准”DSA作为对照，，评价CTA对下肢动脉闭塞症诊断效能(灵敏度、特异度、准确率、阳性预测值和阴性预测值)。 结果：CT血管成像（CTA）在下肢动脉闭塞症狭窄分级的评估中，与“金标准”DSA对比一致性好，诊断效能高，轻度狭窄、中度狭窄、重度狭窄及完全闭塞的灵敏度分别为99.2%、97.5%、95.3%、100%，特异度分别为96.5%、96.1%、96.5%、98.7%，准确度分别为98.2%、97.6%、96.2%、98.2%。 结论：1、CT血管成像（CTA）能精确评估下肢血管闭塞症的狭窄程度，诊断效能可以媲美DSA。 2、CT血管成像（CTA）及其后处理是一种微创、快速、安全的检查方法，可作为下肢动脉闭塞症的首选筛查方法。
[Abstract]:Objective: the incidence of lower extremity arterial obliteration is increasing in China, and lower extremity atherosclerosis and diabetes mellitus are the main causes, which seriously affects the quality of life of middle and old people. Accurate evaluation is critical to the choice of clinical treatment. Digital subtraction angiography (DSAs) is considered to be the "golden standard" for the examination of lower extremity arterial occlusive disease, but it has many disadvantages, such as trauma, complication risk and so on. Since the advent of multislice spiral CT (MSCT), CT angiography has been widely used in clinic because of its safety, speed, noninvasive and high accuracy. The CTA findings of 15 patients with lower extremity arterial occlusive disease were analyzed retrospectively. All patients were examined with DSA within 2 weeks to explore the value of CTA in the diagnosis of the disease. Methods: a total of 15 patients with suspected lower extremity arterial obliteration were examined with 64-row spiral CTA, and each patient was divided into 22 anatomical segments (bilateral common iliac artery and external iliac artery) by DSA examination within two weeks. The internal iliac artery, the superficial femoral artery, the deep femoral artery, the tibiofibular trunk, the posterior tibial artery and the peroneal artery, the stenosis degree of the artery is divided into five grades: normal, mild and 49, moderate and 50. By comparing with DSA and using SPSS17.0 statistical analysis software, the results of DSA and CTA checking methods are processed, and the data of column table with the same bidirectional ordered attributes are obtained. The evaluation results of two independent methods, CTA and DSA, were statistically analyzed by Kappa consistency test to obtain Kappa value and P value. The diagnostic efficacy (sensitivity, specificity) of CTA for lower extremity arterial obliteration was evaluated with "golden standard" DSA as control. Accuracy, positive predictive value and negative predictive value. Results in the evaluation of stenosis grade of lower extremity arterial occlusive disease by using CT angiography, there was good consistency with "golden standard" DSA, and the diagnostic efficacy was high, mild stenosis and moderate stenosis. The sensitivity of severe stenosis and complete occlusion were 99.2 / 97.5 / 95.3 / 100, and the specificity were 96.5and 96.1/ 96.1/ 96.5, respectively. The accuracy was 98.2 / 97.6and 96.298.2respectively. ConclusionCTAA can accurately evaluate the degree of stenosis in lower extremity vascular obliteration, and its diagnostic efficacy is comparable to that of DSA. 2CT angiography (CTAA) and post-processing are a minimally invasive, rapid and safe method, which can be used as the first screening method for lower extremity arterial obliteration.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2


本文编号：1903273