超声检查与CT血管成像检查评价颈动脉狭窄的对比研究

摘要

目的 比较颈动脉超声检查与颈部CT血管成像(CTA)检查评价颈动脉狭窄的价值.方法 选择颈动脉狭窄患者98例,采用颈动脉超声(包括超声造影)及CTA两种方法检查,分析两者在颈动脉狭窄程度、斑块性质、溃疡斑块及颈动脉血栓方面的诊断一致性.结果 (1)98例患者中,颈动脉超声检查与CTA检测不同颈动脉狭窄程度的准确率均较高,两者比较差异无统计学意义(P＞0.05);且两种方法的诊断一致性较好(Kappa值分别为:轻度狭窄0.400,中度狭窄0.496,重度狭窄0.568,闭塞0.795).(2)颈动脉超声检查与CTA在斑块类型(软斑、混合斑及硬斑)的诊断中,两者对软斑及混合斑的诊断一致性较好(软斑Kappa值=0.878;混合斑Kappa值=0.644),对硬斑的诊断一致性较差(Kappa值=0.381).(3)术前颈动脉超声检查对于颈动脉血栓形成及颈动脉溃疡斑块的诊断准确率高于CTA检查,两者差异均有统计学意义(P＜0.01或0.05).结论 颈动脉超声检查与颈部CTA检查在评价颈动脉狭窄程度方面有较好的一致性和准确性;颈动脉超声检查在判断颈动脉粥样硬化斑块类型尤其是溃疡斑块及颈动脉血栓方面具有相对的优越性.%Objective To compare contrast-enhanced ultrasonography(CEUS) with CT angiography (CTA) in assessment of carotid atherosclerotic stenosis.Methods Ninety eight patients with carotid stenosis underwent CEUS and CTA examinations.The diagnostic consistency of two methods for investigating the degree of carotid stenosis,and structural features of plaques,ulcer plaque,carotid thrombosis was analysed.Results There was no significant difference in diagnostic accuracy of carotid stenosis between two methods (P ＞0.05),the Kappa value for mild,moderate and severe stenosis was 0.400,0.496 and 0.568,respectively,that for carotid occlusion was 0.795.There was a good consistency in diagnosis of soft and mixed plaques with a Kappa value of 0.878 and 0.644,respectively;however consistency in diagnosis of hard plaques was less satisfactory with a Kappa value of 0.381.CEUS had a higher diagnosis accuracy than CTA did in thrombosis and ulcer plaques (P＜0.05 and 0.01).Conclusion Carotid CEUS and CTA have a good consistency in diagnosis of carotid stenosis degree and both are consistent with DSA examination.Carotid CEUS is relatively superiority in the detection of carotid atherosclerotic plaque with ulcer and thrombosis.