Rieker O, Düber C, Schmiedt W, von Zitzewitz H, Schweden F, Thelen M
Department of Radiology, Johannes Gutenberg-Universität Mainz, Germany.
AJR Am J Roentgenol. 1996 Feb;166(2):269-76. doi: 10.2214/ajr.166.2.8553929.
The aim of this study was to determine the accuracy of CT angiography (CTA) with a single spiral acquisition for the diagnosis of arterial stenoses and occlusion in patients with peripheral vascular occlusive disease.
In a prospective study, intraarterial digital subtraction angiography and i.v. CTA from the groin to the lower calves were performed on 50 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were produced. The accuracy of CTA with and without analysis of the axial scans was determined with digital subtraction angiography as the standard.
The sensitivities of CTA were 100% for the diagnosis of femoral artery occlusion, 100% for the detection of popliteal artery (including tibial-peroneal arterial trunk) occlusion, and 94% for the detection of tibial artery occlusion. The specificities were 100%, 99%, and 98%, respectively. When maximum-intensity-projection images were interpreted without axial scans, sensitivities were 98%, 85%, and 92% and specificities were 100%, 99%, and 97%, respectively. For the accurate grading of high-grade (75-99%) stenoses of the superficial femoral artery and the popliteal artery (including tibial-peroneal arterial trunk), the sensitivities of CTA were 88% and 73% and the specificities were 94% and 100%, respectively. When maximum-intensity-projection images alone were used, the sensitivities for the correct grading of high-grade stenoses were 58% and 36% and the specificities were 99% and 100%, respectively.
CTA from the groin to the lower calves is feasible, and the short examination time is a significantly advantage over the time required for other noninvasive techniques. CTA is particularly accurate in the depiction of femoral artery occlusions. Maximum-intensity-projection images are useful, but analysis of axial scans is more accurate for the grading of arterial stenoses. The results of CTA are encouraging enough to warrant further studies. A CTA protocol covering the pelvic and pedal vessels remains to be established and evaluated.
本研究旨在确定单螺旋采集的CT血管造影（CTA）对诊断外周血管闭塞性疾病患者动脉狭窄和闭塞的准确性。
在一项前瞻性研究中，对50例血管闭塞性疾病患者进行了动脉内数字减影血管造影及从腹股沟至小腿下部的静脉CTA检查。生成了多个视角的最大密度投影图像。以数字减影血管造影为标准，确定了有无轴位扫描分析的CTA的准确性。
CTA诊断股动脉闭塞的敏感性为100%，检测腘动脉（包括胫腓动脉干）闭塞的敏感性为100%，检测胫动脉闭塞的敏感性为94%。特异性分别为100%、99%和98%。在不进行轴位扫描而解读最大密度投影图像时，敏感性分别为98%、85%和92%，特异性分别为100%、99%和97%。对于准确分级股浅动脉和腘动脉（包括胫腓动脉干）的重度（75%-99%）狭窄，CTA的敏感性分别为88%和73%，特异性分别为94%和100%。当仅使用最大密度投影图像时，重度狭窄正确分级的敏感性分别为58%和36%，特异性分别为99%和100%。
从腹股沟至小腿下部的CTA是可行的，与其他无创技术所需时间相比，检查时间短是一个显著优势。CTA在描绘股动脉闭塞方面特别准确。最大密度投影图像有用，但轴位扫描分析对动脉狭窄分级更准确。CTA的结果令人鼓舞，值得进一步研究。覆盖盆腔和足部血管的CTA方案仍有待建立和评估。
