Link J, Brossmann J, Penselin V, Glüer C C, Heller M
Department of Radiology, Christian-Albrechts-University of Kiel, Germany.
AJR Am J Roentgenol. 1997 Feb;168(2):361-5. doi: 10.2214/ajr.168.2.9016207.
The purpose of this study was to compare the abilities of color-coded duplex sonography, CT angiography, and selective digital subtraction angiography to reveal disease requiring surgery in patients with occlusive disease of the carotid bifurcation.
Fifty-six carotid arteries in 28 patients who had 48 carotid stenoses and symptomatic cerebrovascular disease were prospectively studied by selective digital subtraction angiography, color-coded duplex sonography, and CT angiography. CT data were displayed in maximum intensity projection. The degree of stenoses revealed were graded as mild, moderate, severe, and occluded according to North American Symptomatic Carotid Endarterectomy Trial criteria. The results of CT angiography and color-coded duplex sonography were correlated with the gold standard of digital subtraction angiography.
Grading of stenoses on CT angiography agreed with grading of stenoses on digital subtraction angiography in 89% of cases. All high-grade stenoses and occlusions revealed on CT angiography were correctly interpreted by all observers. For stenoses revealed by color-coded duplex sonography and digital subtraction angiography, observers' agreement was 75%. Two severe stenoses were incorrectly graded as occluded by the interpreter of the color-coded duplex sonograms. Also, one occluded carotid artery was misdiagnosed as moderate stenosis.
Our results indicate that CT angiography is superior to color-coded duplex sonography for evaluating carotid disease and determining disease requiring surgery. CT angiography warrants further investigation in a larger group of patients.
本研究旨在比较彩色编码双功超声、CT血管造影和选择性数字减影血管造影在揭示颈动脉分叉闭塞性疾病患者中需要手术治疗的疾病方面的能力。
对28例患者的56条颈动脉进行前瞻性研究，这些患者有48处颈动脉狭窄和有症状的脑血管疾病，采用选择性数字减影血管造影、彩色编码双功超声和CT血管造影。CT数据以最大密度投影显示。根据北美症状性颈动脉内膜切除术试验标准，将所揭示的狭窄程度分为轻度、中度、重度和闭塞。将CT血管造影和彩色编码双功超声的结果与数字减影血管造影的金标准进行对比。
CT血管造影上的狭窄分级与数字减影血管造影上的狭窄分级在89%的病例中一致。所有观察者对CT血管造影上显示的所有高级别狭窄和闭塞均做出了正确解读。对于彩色编码双功超声和数字减影血管造影所揭示的狭窄，观察者之间的一致性为75%。两名重度狭窄被彩色编码双功超声解读人员错误分级为闭塞。此外，一条闭塞的颈动脉被误诊为中度狭窄。
我们的结果表明，在评估颈动脉疾病和确定需要手术治疗的疾病方面，CT血管造影优于彩色编码双功超声。CT血管造影值得在更大规模的患者群体中进一步研究。
