摘要
目的以数字减影血管造影(DSA)为金标准,分析彩色多普勒超声(CDUS),CT血管成像(CTA)对颈内动脉狭窄、斑块形态及溃疡诊断的准确性。方法采用回顾性分析方法,收集中国医科大学附属第四医院2009—2014年收治的经DSA检查确诊的颈内动脉狭窄患者168例,并先后行CDUS、CTA检查。用Pearson相关性分析CDUS、CTA检查颈内动脉狭窄率与DSA检查颈内动脉狭窄率的相关性;以DSA为金标准,计算CDUS、CTA诊断颈内动脉狭窄率≥70%、斑块形态、是否有溃疡的正确率、灵敏度、特异度、阳性预测值和阴性预测值;ROC曲线和ROC曲线下面积(AUC)分析CDUS、CTA检查对斑块形态和溃疡检测的准确性;Kappa检验分析CDUS、CTA检查与DSA检查的一致性。结果 CDUS(64.73±22.91)%、CTA(62.38±22.31)%检查颈内动脉狭窄率与DSA(62.52±22.31)%检查颈内动脉狭窄率均呈正相关(r值分别为0.922和0.992,P<0.05)。DSA确诊患者颈内动脉狭窄率≥70%的血管条数为146条,<70%的血管条数为190条。CDUS、CTA检查颈内动脉狭窄率≥70%的正确率分别为85.7%(288/336)、95.8%(322/336),灵敏度分别为83.6%(122/146)、94.5%(138/146),特异度分别为87.4%(166/190)、96.8%(184/190),阳性预测值分别为83.6%(122/146)、95.8(138/144)%,阴性预测值分别为87.4%(166/190)、95.8%(184/192)。CDUS、CTA检查诊断颈内动脉狭窄率≥70%的Kappa值分别为0.709、0.915。DSA确诊患者颈内动脉规则型斑块的血管条数为168条,不规则型斑块的血管条数为168条;DSA确诊患者颈内动脉有溃疡的血管条数为68条,无溃疡的血管条数为268条。CDUS、CTA检查颈内动脉斑块形态的正确率分别为82.7%(278/336)、99.1%(333/336),灵敏度分别为84.8%(144/168)、98.8%(166/168),特异度分别为79.8%(134/168)、99.4%(167/168),阳性预测值分别为80.9%(144/178)、99.4%(166/167),阴性预测值分别为84.8%(134/158)、99.4%(167/169);CDUS、CTA检查颈内动脉斑块形态的Kappa值分别为0.655、0.982。CDUS、CTA检查颈内动脉溃疡的正确率分别为88.7%(298/336)、98.5%(331/336),灵敏度分别为85.3%(58/68)、94.0%(64/68),特异度分别为89.6%(240/268)、99.6%(267/268),阳性预测值分别为67.4%(58/86)、98.5%(64/65),阴性预测值分别为96.0%(240/250)、98.5%(267/271)。CDUS检查诊断颈内动脉不规则斑块AUC为0.818〔95%CI(0.711,0.866)〕,CTA检查诊断颈内动脉不规则斑块AUC为0.997〔95%CI(0.923,1.000)〕;CDUS检查诊断颈内动脉溃疡AUC为0.708〔95%CI(0.633,0.788)〕,CTA检查诊断颈内动脉溃疡AUC为0.969〔95%CI(0.934,1.000)〕。CDUS、CTA检查诊断颈内动脉溃疡的Kappa值分别为0.681、0.953。结论CTA检查对于颈内动脉狭窄率≥70%,不规则斑块和有溃疡的诊断具有简单可行且正确率高的优点,较CDUS占有明显优势,与金标准DSA诊断的准确性具有高度一致性,在一定情况下可代替DSA检查,避免其有创性和潜在的危险性。
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） and96. 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 was268. 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 were79. 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 was0. 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.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第30期3763-3768,共6页
Chinese General Practice
