Zhang Zishu, Berg Marja H, Ikonen Aki E J, Vanninen Ritva L, Manninen Hannu I
Department of Clinical Radiology, Kuopio University Hospital, PO Box 1777, 70210 Kuopio, Finland.
Eur Radiol. 2004 Apr;14(4):665-72. doi: 10.1007/s00330-003-2130-2. Epub 2003 Nov 14.
The aim of this study was to assess the reproducibility and anatomical accuracy of automated 3D CT angiography analysis software in the evaluation of carotid artery stenosis with reference to rotational DSA (rDSA). Seventy-two vessels in 36 patients with symptomatic carotid stenosis were evaluated by 3D CT angiography and conventional DSA (cDSA). Thirty-one patients also underwent rotational 3D DSA (rDSA). Multislice CT was performed with bolus tracking and slice thickness of 1.5 mm (1-mm collimation, table feed 5 mm/s) and reconstruction interval of 1.0 mm. Two observers independently performed the stenosis measurements on 3D CTA and on MPR rDSA according to the NASCET criteria. The first measurements on CTA utilized an analysis program with automatic stenosis recognition and quantitation. In the subsequent measurements, manual corrections were applied when necessary. Interfering factors for stenosis quantitation, such as calcifications, ulcerations, and adjacent vessels, were registered. Intraobserver and interobserver correlation for CTA were 0.89 and 0.90, respectively (p<0.001). The interobserver correlation between two observers for MPR rDSA was 0.90 (p<0.001). The intertechnique correlation between CTA and rDSA was 0.69 (p<0.001) using automated measurements but increased to 0.81 (p<0.001) with the manually corrected measurements. Automated stenosis recognition achieved a markedly poorer correlation with MPR rDSA in carotids with interfering factors than those in cases where there were no such factors. Automated 3D CT angiography analysis methods are highly reproducible. Manually corrected measurements facilitated avoidance of the interfering factors, such as ulcerations, calcifications, and adjacent vessels, and thus increased anatomical accuracy of arterial delineation by automated CT angiography with reference to MPR rDSA.
本研究的目的是参照旋转数字减影血管造影（rDSA）评估自动三维CT血管造影分析软件在评估颈动脉狭窄时的可重复性和解剖准确性。对36例有症状颈动脉狭窄患者的72条血管进行了三维CT血管造影和传统数字减影血管造影（cDSA）评估。31例患者还接受了旋转三维数字减影血管造影（rDSA）。采用团注追踪法进行多层CT扫描，层厚1.5mm（准直1mm，床速5mm/s），重建间隔1.0mm。两名观察者根据北美症状性颈动脉内膜切除术试验（NASCET）标准，分别在三维CT血管造影（CTA）和多平面重组rDSA上进行狭窄测量。CTA上的首次测量使用了具有自动狭窄识别和定量功能的分析程序。在随后的测量中，必要时进行手动校正。记录狭窄定量的干扰因素，如钙化、溃疡和相邻血管。CTA的观察者内和观察者间相关性分别为0.89和0.90（p<0.001）。两名观察者在多平面重组rDSA上的观察者间相关性为0.90（p<0.001）。使用自动测量时，CTA与rDSA之间的技术间相关性为0.69（p<0.001），但手动校正测量后增加到0.81（p<0.001）。与无干扰因素的情况相比，在有干扰因素的颈动脉中自动狭窄识别与多平面重组rDSA的相关性明显较差。自动三维CT血管造影分析方法具有高度可重复性。手动校正测量有助于避免溃疡、钙化和相邻血管等干扰因素，从而提高了自动CT血管造影相对于多平面重组rDSA的动脉描绘解剖准确性。
