Department of Radiology, Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Wien, Vienna, Austria.
Eur J Radiol. 2011 Dec;80(3):e351-5. doi: 10.1016/j.ejrad.2010.11.031. Epub 2010 Dec 14.
Accurate stenosis quantification in the carotid arteries is of great clinical importance. We aimed to compare the diagnostic accuracy of multi-slice computed tomography angiography (CTA) to digital subtraction angiography (DSA) for the detection and grading of atherosclerotic lesions involving the supraaortic arteries.
We retrospectively analyzed 30 patients (10 women; mean age, 67 years). CTA was performed after administration of 100 ml Ultravist 370 (Bayer Schering, Germany), at a flow of 5 ml/s, using a Philips Brilliance 16MDCT scanner (Philips, Best, Netherland) at a collimation of 16 mm×0.75 mm prior to DSA. The supraaortic arteries were divided into 17 segments, and, within each segment, the presence and severity of stenotic or occlusive lesions was determined, based on a four-point scale (0-49%, 50-69%, 70-99%, occlusion), by four independent readers using the NASCET criteria. Sensitivity and specificity of MDCT was calculated for the detection of moderate (50-69%) versus significant stenoses (70-99%) and occlusion.
There were 291 segments assessed with both methods. Thirteen lesions were "not assessable" on CTA. DSA identified 53 significant lesions, and CTA 56 significant lesions. With regard to significant lesions, CTA overrated six lesions and underestimated six lesions, resulting in a sensitivity, specificity, and accuracy of 86.4%, 97.6%, and 95.9%, respectively. For the detection of stenoses greater than 50%, sensitivity, specificity, and accuracy were 90.2%, 95.8%, and 94.8%, respectively.
Compared to DSA, CTA shows high accuracy in the detection and grading of lesions involving the supraaortic arteries enabling its use in the detection and treatment planning for stenoses of the supraaortic vessels.
准确评估颈动脉狭窄具有重要的临床意义。本研究旨在比较多层螺旋 CT 血管造影（MSCTA）与数字减影血管造影（DSA）对颅外段动脉粥样硬化性病变的检出及狭窄程度分级的诊断效能。
回顾性分析 30 例患者（10 例女性；平均年龄 67 岁）。采用 16 排螺旋 CT 扫描仪（Philips Brilliance 16MDCT，荷兰飞利浦公司）进行 MSCTA 检查，经肘前静脉以 5ml/s 的流率注射 100ml 优维显 370（德国拜耳先灵公司），管电压 120kV，准直器宽度 16mm×0.75mm。根据 NASCET 标准，将颅外段动脉分为 17 段，由 4 名观察者分别独立对每段血管的狭窄或闭塞病变进行评估，狭窄程度采用 4 分法（049%、50%69%、70%99%、闭塞）。以 DSA 为参考标准，计算 MSCTA 对中重度狭窄（50%69%）及重度狭窄（70%~99%）和闭塞病变的敏感度和特异度。
共评估 291 段血管，其中 13 段病变因 MSCTA 伪影而无法评估。DSA 共检出 53 处狭窄病变，MSCTA 检出 56 处。MSCTA 对狭窄病变的评估较 DSA 高估 6 处，低估 6 处，MSCTA 对狭窄病变的敏感度、特异度和准确度分别为 86.4%、97.6%和 95.9%。MSCTA 对狭窄程度大于 50%病变的敏感度、特异度和准确度分别为 90.2%、95.8%和 94.8%。
MSCTA 对颅外段动脉粥样硬化性病变的检出及狭窄程度分级具有较高的准确性，可用于颅外段动脉狭窄的筛查及治疗方案的制定。
