van Prehn J, Muhs B E, Pramanik B, Ollenschleger M, Rockman C B, Cayne N S, Adelman M A, Jacobowitz G R, Maldonado T S
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2008 Sep;36(3):267-72. doi: 10.1016/j.ejvs.2008.04.016. Epub 2008 Jun 27.
Clinical decision making for carotid surgery depends largely upon stenosis grade. While digital subtraction angiography remains the gold standard for stenosis grading, many physicians use less invasive modalities. The purpose of this study was to compare the results of multidimensional Computed tomography (CTA) with ultrasound (US) grading and peak flow velocity (PSV).
37 stenosed carotid arteries were studied retrospectively in 36 consecutive patients. US grading and PSV were compared to multidimensional CTA analysis (diameter, area and volumetric measurements), performed by a medical software company. Calculations of stenosis percentage on CTA were made using the NASCET and ECST methodology. Diameter measurements were also performed by a neuroradiologist.
All CTA diameter, area and volume measurements had only modest correlation with PSV (r<0.5) and ultrasound grading (p<0.5). There was concordant classification of stenosis grades in only 40-60% of cases. CTA diameter, area and volume measurements had good correlation (0.69<r<0.87) with one another using ECST methodology. Using NASCET methodology on CTA, correlation between diameter and area was insignificant (r=0.32). CTA volumetric analysis with the NASCET method yielded 27 negative stenosis grades. Repeatability coefficient for selecting the normal distal ICA 20 mm more distally was 20% for diameter and 43% for area. CTA diameter interobserver repeatability coefficients were 22.9% (NASCET) and 17.8% (ECST) and 0.7 mm (lumen) and 1.9 mm (vessel).
All CTA measurements showed moderate correlation with both ultrasound grading and PSV. Selection of the level of the normal distal ICA influences the NASCET calculations and can produce discrepant stenosis grades. Multidimensional CTA analysis seems to have no additional value for stenosis grading, but provides other useful anatomic information.
颈动脉手术的临床决策很大程度上取决于狭窄程度。虽然数字减影血管造影仍是狭窄分级的金标准，但许多医生使用侵入性较小的检查方法。本研究的目的是比较多维计算机断层扫描（CTA）与超声（US）分级及峰值流速（PSV）的结果。
对36例连续患者的37条狭窄颈动脉进行回顾性研究。将US分级和PSV与由一家医学软件公司进行的多维CTA分析（直径、面积和容积测量）进行比较。使用北美症状性颈动脉内膜切除术试验（NASCET）和欧洲颈动脉外科试验（ECST）方法计算CTA上的狭窄百分比。直径测量也由一名神经放射科医生进行。
所有CTA直径、面积和容积测量与PSV（r<0.5）和超声分级（p<0.5）仅具有中等相关性。仅40%-60%的病例狭窄程度分级一致。使用ECST方法时，CTA直径、面积和容积测量彼此之间具有良好的相关性（0.69<r<0.87）。在CTA上使用NASCET方法时，直径与面积之间的相关性不显著（r=0.32）。采用NASCET方法的CTA容积分析得出27个负性狭窄分级。在更远处选择正常颈内动脉（ICA）远端20 mm的重复性系数，直径为20%，面积为43%。CTA直径的观察者间重复性系数分别为22.9%（NASCET）和17.8%（ECST），管腔为0.7 mm，血管为1.9 mm。
所有CTA测量与超声分级和PSV均显示中等相关性。正常ICA远端水平的选择会影响NASCET计算，并可能产生不一致的狭窄分级。多维CTA分析似乎对狭窄分级没有额外价值，但可提供其他有用的解剖学信息。
Zotero 插件