CT血管成像对颅外颈内动脉夹层的诊断价值研究
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摘要
目的探讨CT血管成像(CTA)对颅外颈内动脉夹层(EICAD)的诊断价值。方法回顾性分析22例(23支) EICAD患者和20例(20支)颈内动脉粥样硬化患者,以DSA结果为金标准,由两名放射科医师独立对CT图像进行分析,评估CTA诊断EICAD的敏感性、特异性和准确性,采用Kappa检验评估CTA和DSA的一致性。测量表现为狭窄或闭塞的EICAD和粥样硬化组颈动脉窦上最宽管径、最窄管径及相应位置对侧管径值,记录最宽管径/对侧管径和最窄管径/对侧管径的比值,通过Mann-Whitney U检验比较夹层组和粥样硬化组数据。结果 22例患者共44支颈内动脉,DSA诊断23支EICAD,CTA诊断22支,误诊1支。CTA诊断EICAD的敏感性、特异性和准确性分别为95. 6%、100%和97. 7%,与DSA一致性好(Kappa值为0. 955,P <0. 001)。夹层组在最宽管径(Z=-4. 24,P <0. 001)、最窄管径(Z=-3. 94,P <0. 001)、最宽/对侧管径(Z=-4. 25,P <0. 001)、最窄/对侧管径(Z=-4. 19,P <0. 001)均高于粥样硬化组。结论 CTA能显示EICAD多种表现形式,管壁增厚、管径增宽是EICAD敏感、准确的CT征象。
Objective To explore the diagnostic value of CT angiography( CTA) in extracranial internal carotid artery dissections( EICAD). Methods We retrospectively enrolled 22 patients with extracranial internal carotid artery dissections( 20 branches) and 20 patients with internal carotid artery arteriosclerosis( 23 branches) with DSA examinations serving as the gold standard. Two radiologists independently analyzed CTA images to determine the sensitivity,specificity and accuracy of CTA for diagnosing EICAD. The consistency of DSA and CTA results were evaluated by Kappa test. The widest diameter,narrowest diameter and the diameter of corresponding contralateral carotid artery were measured above the carotid sinus in EICAD group where stenosis or occlusion was present and arteriosclerosis group,respectively. Ratios of the widest diameter/diagonal diameter and the narrowest diameter/diagonal diameter of the two groups was calculated. The results of dissections group and arteriosclerosis group were compared with the Mann-Whitney U test. Results A total of 22 branches in 44 internal carotid arteries were diagnosed as EICAD by DSA,22 branches were diagnosed as EICAD by CTA,1 branch was misdiagnosis. The sensitivity,specificity,accuracy of CT angiography for diagnosing EICAD were 95. 6%,100% and97. 7%,respectively. The CTA results were in good agreement with DSA( Kappa = 0. 955,P < 0. 0010). The widest diameter( Z =-4. 24,P < 0. 001),the narrowest diameter( Z =-3. 94,P < 0. 001),the widest/contralateral diameter( Z =-4. 25,P < 0. 001) as well as the narrowest/contralateral diameter( Z =-4. 19,P < 0. 001) were all significantly higher in EICAD group than those in atherosclerosis group. Conclusion CT angiography could show a variety of EICAD manifestations. Wall thickening and diameter widening were sensitive and accurate CT features for the diagnosis of EICAD.
Objective To explore the diagnostic value of CT angiography( CTA) in extracranial internal carotid artery dissections( EICAD). Methods We retrospectively enrolled 22 patients with extracranial internal carotid artery dissections( 20 branches) and 20 patients with internal carotid artery arteriosclerosis( 23 branches) with DSA examinations serving as the gold standard. Two radiologists independently analyzed CTA images to determine the sensitivity,specificity and accuracy of CTA for diagnosing EICAD. The consistency of DSA and CTA results were evaluated by Kappa test. The widest diameter,narrowest diameter and the diameter of corresponding contralateral carotid artery were measured above the carotid sinus in EICAD group where stenosis or occlusion was present and arteriosclerosis group,respectively. Ratios of the widest diameter/diagonal diameter and the narrowest diameter/diagonal diameter of the two groups was calculated. The results of dissections group and arteriosclerosis group were compared with the Mann-Whitney U test. Results A total of 22 branches in 44 internal carotid arteries were diagnosed as EICAD by DSA,22 branches were diagnosed as EICAD by CTA,1 branch was misdiagnosis. The sensitivity,specificity,accuracy of CT angiography for diagnosing EICAD were 95. 6%,100% and97. 7%,respectively. The CTA results were in good agreement with DSA( Kappa = 0. 955,P < 0. 0010). The widest diameter( Z =-4. 24,P < 0. 001),the narrowest diameter( Z =-3. 94,P < 0. 001),the widest/contralateral diameter( Z =-4. 25,P < 0. 001) as well as the narrowest/contralateral diameter( Z =-4. 19,P < 0. 001) were all significantly higher in EICAD group than those in atherosclerosis group. Conclusion CT angiography could show a variety of EICAD manifestations. Wall thickening and diameter widening were sensitive and accurate CT features for the diagnosis of EICAD.
引文
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7中华医学会神经病学分会.中国颈部动脉夹层诊治指南2015[J].中华神经科杂志,2015,48:644-651.
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11蒋春秀,黄凡衡,黄钟情,等.3D-VISTA在自发性头颈动脉夹层中的诊断价值[J].临床放射学杂志,2017,36:475-479.
2王岚,那世杰,杨咏波,等.颈-颅动脉夹层的临床和影像学特征分析[J].中国脑血管病杂志,2009,6:590-592.
3 Leclerc X,Lucas C,Godefroy O,et al.Helical CT for the follow-up of cervical internal carotid artery dissections[J].American Journal of Neuroradiology,1998,19:831-837.
4 Shakir HJ,Davies JM,Shallwani H,et al.Carotid and Vertebral Dissection Imaging[J].Current Pain&Headache Reports,2016,20:68.
5 de Bray JM,Baumgartner RW.History of spontaneous dissection of the cervical carotid artery[J].Arch Neurol,2005,62:1168-1170.
6 Rodallec MH,Marteau V,Gerber S,et al.Craniocervical arterial dissection:spectrum of imaging findings and differential diagnosis.[J].Radiographics A Review Publication of the Radiological Society of North America Inc,2008,28:1711-1728.
7中华医学会神经病学分会.中国颈部动脉夹层诊治指南2015[J].中华神经科杂志,2015,48:644-651.
8 Debette S,Grond-Ginsbach C,Bodenant M,et al.Differential features of carotid and vertebral artery dissections:the CADISP study[J].Neurology,2011,77:1174-1181.
9 Leclerc X,Godefroy O,Salhi A,et al.Helical CT for the diagnosis of extracranial internal carotid artery dissection[J].Stroke,1996,27:461-466.
10 Ahn SS,Kim BM,Suh SH,et al.Spontaneous symptomatic intracranial vertebrobasilar dissection:initial and follow-up imaging findings[J].Radiology,2012,264:196-202.
11蒋春秀,黄凡衡,黄钟情,等.3D-VISTA在自发性头颈动脉夹层中的诊断价值[J].临床放射学杂志,2017,36:475-479.