目的：探讨64层螺旋CT血管成像在诊断椎基底动脉供血不足中的应用价值。方法693例临床诊断或拟诊为椎基底动脉供血不足的患者行头颈部64层螺旋CT血管成像检查。23例在64层螺旋CT血管成像检查后5～10 d内行（DSA）检查。采用双盲法对所有计数资料采用χ2检验进行统计分析；以DSA为“金标准”，对64层螺旋CT血管成像和DSA发现椎基底动脉狭窄的结果进行统计分析。结果左椎动脉及右椎动脉各段狭窄差别有统计学意义（P＜0.05）。对双侧椎动脉不同性质的斑块在椎动脉各段的分布进行多组频数分布的χ2检验，差别有统计学意义（P＜0.05）。23例患者46条椎动脉既行CTA检查又行DSA检查，以DSA为“金标准”，将检查结果进行对照研究和统计分析，差别无统计学意义（P＝0.774，P＞0.05），同时采用Kappa检验评价CTA对椎基底动脉狭窄的诊断价值（Kappa＝0.803，P＝0.000，P＜0.05，Kappa＞0.75），CTA对椎基底动脉狭窄诊断的敏感度81.6%，特异度97.0%，准确度94.2%，阳性预测值86.1%，阴性预测值95.9%。结论64层螺旋CT血管成像能够清晰显示粥样硬化斑块的性质及周围组织的变化情况，对椎基底动脉供血不足的诊断具有较高的应用价值。%Objective To assess the value of 64-slice spiral CT angiography(CTA)in the diagnosis of vertebrobasilar insufficiency.Methods 693 patients with suspected vertebrobasilar insufficiency underwent 64-slice CTA.Digital subtraction angiography(DSA)was also performed on 23 patients within 5 to 10 days of CTA.The CTA was analyzed using DSA as gold standard. Results There was significant difference in the degree of stenosis and distribution of plaques among the segments of right and left vertebral arteries(P<0.05).There was no significant difference(P=0.774)between CTA and DSA in 23 patients with significant concordance rate(Kappa=0.803,P=0).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CTA were 81.6%,97.0%,94.2%,86.1%,and 95.9%,respectively.Conclusions 64-slice CTA can clearly display the characteristics of atherosclerotic plaques and lumen stenosis of vertebrobasilar artery.CTA is valuable in the diagnosis of vertebrobasilar insufficiency.
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