Noaparast M, Rabani A, Karimian F, Bodaghabadi M, Aran S, Mirsharifi R, Jafarian A, Vaezi F, Ghanaati H
Assistant Professor, Department of Surgery, Shohadaye Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran.
Iran J Radiol. 2011 Sep;8(2):89-96. Epub 2011 Sep 25.
BACKGROUND/OBJECTIVE: The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography (MSCTA) in run-off and cut-off sites of arterial disease.
Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease (AD) all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93) years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively.
Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases (81.6%). Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%).
MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis.
背景/目的：准确的动脉疾病解剖定位及严重程度判定对老年人这一重要健康问题具有重要意义。我们旨在确定64层CT血管造影（MSCTA）在动脉疾病的流出道和截断部位的诊断价值。
在整个研究过程中，对38例有动脉疾病（AD）临床体征和症状且均有血管手术指征的患者进行了MSCTA检查，随后进行手术干预。患者的平均年龄为34±15.86（范围23至93）岁。使用64层CT扫描仪进行MSCTA检查，在动脉期通过高压注射器以5 ml/秒的速率将非离子型造影剂注入肘前静脉，并在术中对外周动脉疾病进行探查和血运重建。
动脉粥样硬化和动脉疾病作为血管闭塞的最常见原因，在下肢更为常见。根据MSCTA检查结果，最常发生狭窄的部位是股浅动脉。Spearman相关系数显示评估者之间具有高度一致性。与手术相比，MSCTA的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为83.8%、96%、96.8%、81.3%和89%。将MSCTA检查结果与作为参考标准的手术结果进行比较，结果显示在大多数病例（81.6%）中两者一致。MSCTA在97.3%的患者中正确识别了截断部位，最常见的不一致部位是流出道（18.2%）。
MSCTA血管造影作为一种新型诊断方法，可能是常规临床诊断的合适替代方法和可行选择。
