Imaging value of 64-slice CT angiography and digital subtraction angiography in lower limb arteriosclerosis obliterans in diabetic patients
-
摘要:
目的 分析64层CT血管成像(64-CTA)与数字减影血管造影(DSA)在糖尿病患者下肢动脉硬化闭塞症中的影像学价值。 方法 收集2019年5月~2021年5月在我院确诊为糖尿病下肢动脉下肢动脉闭塞症的200例患者的64-CTA及DSA的资料,所有患者均先行64-CTA检查,24 h后行DSA检查,两种检查间隔均不超过2周。以DSA为金标准,计算64-CTA诊断糖尿病下肢动脉硬化闭塞症的敏感度、特异性、准确度、阳性预测值、阴性预测值,并计算64-CTA三种处理方式诊断符合率。 结果 200例患者中有64-CTA与DSA对照的共2265节段,以DSA为金标准,64-CTA发现有2115个节段与DSA一致,诊断符合率为93.38%。64-CTA高估1级共86节段,低估1级共53节段,绘制64-CTA与DSA显示下肢动脉狭窄分级节段分布曲线图,Kappa一致性检验结果显示Kappa值=0.915(P < 0.01)。以DSA为金标准,64-CTA诊断糖尿病下肢动脉硬化闭塞症有狭窄的敏感度为97.27%、特异性为98.17%、准确度为97.62%、阳性预测值为98.83%、阴性预测值为95.76%,对各个诊断界点的诊断效能均较高。以DSA为金标准,64-CTA-MIP符合率为88.74%,64-CTA-MPR符合率为92.98%,64-CTA-VR符合率为88.74%,64-CTA-MIP、64-CTA-VR诊断符合率明显低于64-CTA(P < 0.05)。病例图像分析发现64-CTA显示的狭窄程度较DSA更接近真实情况。 结论 64-CTA可准确显示糖尿病下肢动脉硬化闭塞症的狭窄程度,与DSA检查一致性较高,可作为该疾病的首要筛选检查方法。 Abstract:Objective To analyze the imaging value of 64-slice CT angiography (64-CTA) and digital subtraction angiography (DSA) in lower limb arteriosclerosis obliterans in diabetic patients. Methods The data of 64-CTA and DSA of 200 patients with diabetic lower limb arterial occlusive disease diagnosed in our hospital from May 2019 to May 2021 were collected. All patients underwent 64-CTA examination, and DSA examination was performed after 24 h. The interval between the two examinations was not more than 2 weeks. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 64-CTA in the diagnosis of diabetic lower extremity arteriosclerosis obliterans were calculated using DSA as the gold standard. The diagnostic coincidence rates of the three treatment methods of 64-CTA were calculated. Results A total of 2265 segments of 200 patients were compared between 64-CTA and DSA. Taking DSA as the gold standard, 2115 segments of 64-CTA were consistent with DSA, with a diagnostic coincidence rate of 93.38%. 64-CTA overestimated grade 1 by 86 times and underestimated grade 1 by 53 times. The distribution curve of 64-CTA and DSA showing the grade of lower limb arterial stenosis was drawn. The results of kappa agreement test showed that the kappa value=0.915 (P < 0.01). Taking DSA as the gold standard, 64-CTA had a sensitivity of 97.27%, specificity of 98.17%, accuracy of 97.62%, positive predictive value of 98.83% and negative predictive value of 95.76% for diagnosing diabetic lower extremity arteriosclerosis obliterans, with a high diagnostic efficacy for each diagnostic cut-off point. The coincidence rate of 64-CTA-MIP was 88.74%, the coincidence rate of 64-CTA-MPR was 92.98%, and the coincidence rate of 64-CTA-VR was 88.74%, and the diagnostic coincidence rate of 64-CTA-MIP and 64-CTA-VR was significantly lower than that of 64-CTA (P < 0.05). Image analysis showed that the degree of stenosis displayed by 64-CTA was closer to the true situation than that of DSA. Conclusion 64-CTA can accurately show the degree of stenosis in diabetic lower extremity arteriosclerosis obliterans, with high consistency with DSA examination. -
表 1 64-CTA与DSA显示下肢动脉狭窄分级节段数比较
Table 1. Comparison of the number of graded segments of lower extremity arterial stenosis by 64-CTA and DSA (n)
64-CTA DSA 正常 轻度狭窄 中度狭窄 重度狭窄 闭塞 合计 正常 594 11 0 0 0 605 轻度狭窄 16 419 26 0 0 461 中度狭窄 0 16 302 27 0 345 重度狭窄 0 0 27 535 0 562 闭塞 0 0 0 27 265 292 合计 610 446 355 589 265 2265 64-CTA:64层CT血管成像;DSA:数字减影血管造影. 表 2 64-CTA诊断糖尿病下肢动脉狭窄的效率
Table 2. Efficiency of 64-CTA in diagnosing diabetic lower extremity arterial stenosis
诊断界点 诊断效能(%) 敏感度 特异性 准确度 阳性预测值 阴性预测值 有狭窄 97.27 98.17 97.62 98.83 95.76 轻度狭窄 90.89 98.50 96.95 93.95 97.69 中度狭窄 87.53 97.24 95.76 85.07 97.75 重度狭窄 90.83 98.39 96.42 95.20 96.83 有闭塞 100.00 98.65 98.81 90.75 100.00 表 3 64-CTA三种处理方式诊断符合率比较
Table 3. Comparison of the diagnostic compliance rate of the three treatments of 64-CTA
检杳方式 例数 与DSA符合 符合率(%) χ2 P 64-CTA 2265 2115 93.38 64-CTA-MIP 2265 2010 88.74 29.895 < 0.001 64-CTA-MPR 2265 2106 92.98 0.281 0.596 64-CTA-VR 2265 2010 88.74 29.895 < 0.001 -
[1] 袁丁, 赵纪春, 王铁皓, 等. 下肢动脉硬化闭塞症最新指南解读及意义[J]. 中国普外基础与临床杂志, 2018, 25(1): 25-31. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL201801008.htm [2] 段晓莉, 穆研, 赵苏云, 等. 2型糖尿病患者下肢动脉硬化闭塞症的超声特征及影响因素分析[J]. 临床超声医学杂志, 2019, 21(3): 239-40. doi: 10.3969/j.issn.1008-6978.2019.03.032 [3] Abdelbary MH, Mohamed AE, Abdel-Hamid A. Accuracy and safety of CO2 digital subtraction angiography during endovascular treatment of symptomatic peripheral artery occlusive disease. A prospective study on Egyptian patients[J]. Egypt J Radiol Nucl Med, 2018, 49(1): 76-84. doi: 10.1016/j.ejrnm.2017.08.014 [4] 罗雯, 傅颖. ECT联合B超、CT检查对甲状腺癌诊断的临床价值[J]. 中南医学科学杂志, 2020, 48(5): 509-12. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYY202005016.htm [5] Smith JM, Fox CJ, Brazaitis MP, et al. Sixty-four-slice CT angiography to determine the three dimensional relationships of vascular and soft tissue wounds in lower extremity war time injuries [J]. Mil Med, 2010, 175(1): 65-7. doi: 10.7205/MILMED-D-00-4509 [6] 郑亚成. 64排CTA在下肢动脉硬化闭塞症患者介入治疗中的应用[J]. 中国CT和MRI杂志, 2021, 19(12): 184-6. doi: 10.3969/j.issn.1672-5131.2021.12.056 [7] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 2型糖尿病基层诊疗指南(实践版·2019[) J]. 中华全科医师杂志, 2019, 18 (9): 810-8. doi: 10.3760/cma.j.issn.1671-7368.2019.09.003 [8] 马英, 徐晓旭. 下肢血管彩超诊断下肢动脉硬化闭塞症的临床价值[J]. 中国保健营养, 2020, 30(12): 361. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202022116.htm [9] 黄文芳, 陈容梅, 谢秀娟, 等. 老年2型糖尿病患者发生下肢动脉硬化闭塞症的影响因素分析[J]. 临床医学工程, 2020, 27(7): 977-8. doi: 10.3969/j.issn.1674-4659.2020.07.0977 [10] 仰涢霞, 姚志伟, 向四国. 糖尿病下肢动脉硬化闭塞症诊断中螺旋CT的应用及其临床价值[J]. 中国实用医药, 2019, 14(8): 4-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201908002.htm [11] Marques C, Dias-Neto M, Sampaio S. Clinical outcomes after digital subtraction angiography versus computed tomography angiography in the preoperative evaluation of lower limb peripheral artery disease[J]. Rev Port Cir Cardiotorac Vasc, 2018, 25(3/4): 133-40. [12] Hansen K, Hansen P, Ewertsen C, et al. Vector flow imaging compared with digital subtraction angiography for Stenosis assessment in the superficial femoral artery – A study of vector concentration, velocity ratio and Stenosis degree percentage[J]. Ultrasound Int Open, 2019, 5(2): E53-9. doi: 10.1055/a-0853-2002 [13] 杨建威, 高超. 三维对比增强磁共振血管造影诊断下肢动脉硬化闭塞症的价值[J]. 中国医学装备, 2019, 16(9): 83-6. doi: 10.3969/J.ISSN.1672-8270.2019.09.022 [14] 沈永玲, 朱海暴, 李勇, 等. CTA结合CTP对预测急性脑梗死患者静脉溶栓预后的价值[J]. 川北医学院学报, 2020, 35(2): 280-2. doi: 10.3969/j.issn.1005-3697.2020.02.026 [15] Foldyna B, Lo J, Mayrhofer T, et al. Individual coronary plaque changes on serial CT angiography: within-patient heterogeneity, natural history, and statin effects in HIV[J]. J Cardiovasc Comput Tomogr, 2020, 14(2): 144-8. doi: 10.1016/j.jcct.2019.08.011 [16] 蔡华琦, 傅菲, 汪洋, 等. CT血管成像分析下肢动脉硬化闭塞症患者主-髂动脉和肠系膜上动脉狭窄的相关性[J]. 中华危重病急救医学, 2018, 30(7): 635-9. doi: 10.3760/cma.j.issn.2095-4352.2018.07.004 [17] 王楠, 郑晓静, 于晓君, 等. 4D-CTA在下肢动脉硬化闭塞症中的应用效果[J]. 中国城乡企业卫生, 2021, 36(8): 7-10. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCXW202108004.htm [18] 黄叶明, 王凯, 黄雪珍. MR血管成像及CTA对下肢动脉硬化性闭塞症动脉狭窄的诊断价值分析[J]. 现代医用影像学, 2018, 27(6): 1873- 5. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY201806016.htm [19] 林洁. 64层CT血管成像与磁共振检查在糖尿病下肢动脉硬化闭塞症诊断中的对比分析[J]. 实用糖尿病杂志, 2020, 16(5): 16-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LNSY202005016.htm [20] 刘衡, 冉启胜, 邓洋, 等. CTA诊断糖尿病下肢动脉临床分期及下肢动脉狭窄程度的应用价值[J]. 西部医学, 2019, 31(4): 620-4. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201904036.htm [21] Drews E, Mathews A, Nast J, et al. 166EMF prospective comparison of 3D point of care ultrasound and CT angiography for carotid Stenosis [J]. Ann Emerg Med, 2020, 76(4): S64-5.