张圆圆 1孟秀君 1田沈 1车玉琴 1林巧 1颜丙旺1
作者信息
- 1. 110032辽宁省沈阳市，中国医科大学附属第四医院神经内科
- 折叠
摘要
Abstract
Objective To analyze the accuracy of colour Doppler ultrasonography ( CDUS) and computed tomography angiography (CTA) in the diagnosis of internal carotid artery stenosis , plaque morphology and ulcer with DSA as the gold standard.Methods A retrospective analysis was conducted on the collected data of 168 patients with internal carotid artery stenosis diagnosed by DSA who were admitted into the Fourth Hospital Affiliated to China Medical University from 2009 to 2014, and CDUS and CTA were undertaken successively.Pearson correlation analysis was conducted on the correlation between the rates of internal carotid artery stenosis screened by CDUS and CTA and the rate of internal carotid artery stenosis screened by DSA ;with DSA as golden criteria , we worked out the number of subjects diagnosed as internal carotid artery stenosis degree ≥70%, plaque morphology, the accuracy of ulcer diagnosis , sensitivity, specificity, positive predictive value and negative predictive value;the accuracy of CDUS and CTA in the diagnosis of plaque morphology and ulcer were was analyzed by ROC curve and AUC ; the consistency of the results of CDUS , CTA and DSA was analyzed by Kappa test.Results There was positive correlation among CDUS (64.73 ±22.91 )%, CTA ( 62.38 ±22.31 )% and DSA ( 62.52 ±22.31 )% in the rate of internal carotid artery stenosis (r=0.922 and 0.992, P<0.05) .The number of blood vessels with internal carotid artery stenosis degree ≥70%diagnosed by DSA was 146, and the number of that <70% was 190.The accuracy rates of CDUS and CTA diagnosing blood vessels with internal carotid artery stenosis degree≥70% were 85.7% (288/336) and 95.8% (322/336) respectively; the sensitivity degrees were 83.6% ( 122/146 ) and 94.5% ( 138/146 ); the specificity degrees were 87.4% ( 166/190 ) and 96.8% (184/190); the positive predictive values were 83.6% (122/146) and 95.8 (138/144)%; the negative predictive values were 87.4% (166/190) and 95.8% (184/192) respectively.The Kappa values of CDUS and CTA diagnosing internal carotid artery stenosis degree≥70% were 0.709 and 0.915 respectively.The number of blood vessels of internal carotid artery with regular plaque diagnosed by DSA was 168, and the number of blood vessels with irregular plaque was 168; the number of blood vessels of internal carotid artery with ulcer diagnosed by DSA was 68, and the number of blood vessels without ulcer was 268.The accuracy rates of CDUS and CTA diagnosing ulcer of internal carotid artery were 82.7% (278/336) and 99.1% (333/336) respectively;the sensitivity degrees were 84.8% ( 144/168 ) and 98.8% ( 166/168 ); the specificity degrees were 79.8% (134/168) and 99.4% (167/168);the positive predictive values were 80.9% (144/178) and 99.4% (166/167);the negative predictive values were 84.8% (134/158) and 99.4% (167/169) respectively.The accuracy rates of CDUS and CTA diagnosing ulcer of internal carotid artery were 88.7% ( 298/336 ) and 98.5% ( 331/336 ) respectively; the sensitivity degrees were 85.3% ( 58/68 ) and 94.0% ( 64/68 ); the specificity degrees were 89.6% ( 240/268 ) and 99.6% ( 267/268);the positive predictive values were 67.4% (58/86) and 98.5% (64/65);the negative predictive values were 96.0%(240/250) and 98.5% (267/271) respectively.The AUC of CDUS diagnosing the irregular plaque of internal carotid artery was 0.818 〔95%CI ( 0.711, 0.866)〕, and the AUC of CTA diagnosing the irregular plaque of internal carotid artery was 0.997〔95%CI (0.923, 1.000)〕;the AUC of CDUS diagnosing the ulcer of internal carotid artery was 0.708 〔95%CI (0.633, 0.788)〕, and the AUC of CTA diagnosing the ulcer of internal carotid artery was 0.969 〔95%CI (0.934, 1.000)〕 .The Kappa values of CDUS and CTA diagnosing ulcer of internal carotid artery were 0.681 and 0.953 respectively.Conclusion CTA is simple and feasible and has high accuracy degree in the diagnosis of internal carotid artery stenosis degree ≥70%, irregular plaque and ulcer , which is superior to CDUS and highly consistent with the diagnosis by DSA.Therefore , CTA can be used as a substitute of DSA in some cases , so as to avoid invasiveness and potential risk.关键词
颈动脉狭窄/超声检查, 多普勒, 彩色/体层摄影术, 螺旋计算机/血管造影术, 数字减影/灵敏度/特异度Key words
Carotid stenosis/Ultrasonography, Doppler, color/Tomography, spiral computed/Angiography, digital subtraction/Sensitivity/Specificity分类
医药卫生
