本文關(guān)鍵詞：頸動(dòng)脈彩超、CTA與DSA評(píng)估頸動(dòng)脈病變準(zhǔn)確性的對(duì)比研究　出處：《重慶醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 彩色多普勒超聲 CT血管成像技術(shù) 數(shù)字減影血管造影術(shù) 頸動(dòng)脈狹窄 頸動(dòng)脈粥樣硬化斑塊

【摘要】：目的：探討彩色多普勒超聲(color doppler sonography,CDS)、CT血管成像技術(shù)(computed tomography angiography,CTA)及數(shù)字減影血管造影(digital subtraction angiography,DSA)技術(shù)在檢測(cè)頸動(dòng)脈病變中的臨床應(yīng)用價(jià)值。材料與方法：收集313名懷疑有頸動(dòng)脈病變并完成腦DSA檢查患者的臨床資料,部分完成頸動(dòng)脈彩超及/或頸動(dòng)脈CTA檢查；評(píng)估頸動(dòng)脈彩超、CTA、彩超與CTA聯(lián)合檢查在檢測(cè)頸動(dòng)脈狹窄及斑塊中的靈敏度、特異度、準(zhǔn)確度、約登指數(shù)、陽(yáng)性似然比,陰性似然比；采用配對(duì)卡方檢驗(yàn)、多組等級(jí)計(jì)數(shù)資料秩和檢驗(yàn)及受試者工作特征曲線(receiver operating characteristic, ROC曲線)分析評(píng)價(jià)三種方法的差異性(P0.05統(tǒng)計(jì)學(xué)有意義)。結(jié)果：1.以DSA檢出頸動(dòng)脈狹窄為參考標(biāo)準(zhǔn),檢出頸動(dòng)脈狹窄病變的靈敏度：彩超71.9%,CTA82.6%,彩超聯(lián)合CTA89.1%；特異度：彩超79.7%,CTA84.9%,彩超聯(lián)CTA 77.6%；準(zhǔn)確度：彩超75.3%,CTA83.4%,彩超聯(lián)合CTA 86.2%；漏診率：彩超28.1%,CTA 17.4%,彩超聯(lián)合CTA 10.9%；誤診率：彩超20.3%,CTA15.1%,彩超聯(lián)合CTA22.4%,約登指數(shù)：彩超0.516,CTA0.675,彩超聯(lián)合CTA0.667；陽(yáng)性似然比：彩超3.5419,CTA5.4702,彩超聯(lián)合CTA 3.9777；陰性似然比：彩超0.3526,CTA0.2049,彩超聯(lián)合CTA0.1405;χ2:彩超78.746,CTA 90.199,彩超聯(lián)合CTA81.829；K：彩超：0.508,CTA0.648,彩超聯(lián)合CTA0.645； ROC曲線下面積：彩超0.758,CTA 0.838,彩超聯(lián)合CTA 0.833；AUC分析提示與DSA相比,彩超(P=0.027)、CTA(P=0.041)差異有統(tǒng)計(jì)學(xué)意義,彩超聯(lián)合CTA檢查與DSA比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.442)。2.以頸動(dòng)脈彩超檢出斑塊為參考標(biāo)準(zhǔn),檢出頸動(dòng)脈斑塊的靈敏度：CTA90.4%,DSA71.1%;特異度：CTA96.3%,DSA 98.5%；準(zhǔn)確度：CTA92.9%,DSA 77.3%；漏診率：CTA9.6%,DSA 28.9%；誤診率：CTA3.7%,DSA 1.5%；約登指數(shù)：CTA0.867,DSA0.696；陽(yáng)性似然比：CTA 24.4324,DSA47.4:陰性似然比：CTA0.0997,DSA0.2934；χ2:CTA144.34,DsA103.22；P值：CTA0.057, DSA0.000；K:CTA0.855,DSA 0.519:ROC曲線下面積：CTA0.925, DSA0.747。AUC分析提示CTA與頸動(dòng)脈彩超相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.057),DSA與頸動(dòng)脈彩超比較有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。結(jié)論：在評(píng)估頸動(dòng)脈狹窄的非侵入性檢查方法中,彩超聯(lián)合CTA檢查是較準(zhǔn)確的方法,略優(yōu)于單一CTA檢查(86.2%vs83.4%),遠(yuǎn)遠(yuǎn)優(yōu)于單一頸動(dòng)脈彩超檢查(86.2%vs75.3%)。與DSA比較,彩超一致性中等,彩超聯(lián)合CTA一致性較高,兩者聯(lián)合檢查可早期篩查頸動(dòng)脈狹窄病變。在評(píng)估頸動(dòng)脈斑塊性質(zhì)的方法中,CTA檢查的準(zhǔn)確性遠(yuǎn)遠(yuǎn)優(yōu)于DSA(92.9%vs77.3%)。CTA與彩超比較,檢查結(jié)果的一致性較好。CTA可作為評(píng)估頸部血管病變的重要方法。
[Abstract]:Objective: To investigate the effect of color Doppler ultrasound (color Doppler, sonography, CDS), CT angiography (computed tomography angiography, CTA) and digital subtraction angiography (digital subtraction angiography DSA) technology in clinical detection of carotid artery disease in the application value. Materials and methods: collected 313 suspected carotid artery disease and complete the clinical data of patients with cerebral DSA examination, part of the completion of carotid artery ultrasonography and / or CTA examination of carotid artery; evaluation of carotid artery ultrasonography, CTA, sensitivity, ultrasound combined with CTA examination in detection of carotid artery stenosis and plaque specificity, accuracy, Youden index, positive likelihood ratio, and negative likelihood ratio; paired card square test, multiple level count data, rank sum test and receiver operating characteristic curve (receiver operating characteristic, ROC curve) analysis of differences of the three evaluation methods of the statistics (P0.05 Meaningful). Results: 1. carotid artery stenosis as the reference standard for DSA detection, the sensitivity of the detection of carotid stenosis: 71.9% CTA82.6%, color Doppler ultrasound, color Doppler ultrasound combined with CTA89.1%; specificity: Color Doppler 79.7%, CTA84.9%, CTA 77.6% color Doppler ultrasound; accuracy: 75.3% CTA83.4%, color Doppler ultrasound, color Doppler ultrasound combined with CTA 86.2%; the rate of misdiagnosis. Ultrasound 28.1%, CTA 17.4%, CTA 10.9% color Doppler ultrasound combined with color Doppler ultrasound; misdiagnosis rate of 20.3%, CTA15.1%, CTA22.4% color Doppler ultrasound combined with color Doppler ultrasound in 0.516, Youden index: CTA0.675, CTA0.667, color Doppler ultrasound combined with positive likelihood ratio: 3.5419; color Doppler ultrasound, color Doppler ultrasound combined with CTA5.4702, CTA 3.9777; negative likelihood ratio: 0.3526 CTA0.2049, color Doppler ultrasound, color Doppler ultrasound combined with CTA0.1405 x 2:; ultrasound 78.746, CTA 90.199, CTA81.829 color Doppler ultrasound combined with color Doppler ultrasound: 0.508; K: CTA0.648, CTA0.645, color Doppler ultrasound combined with color Doppler ultrasound; the area under ROC curve: 0.758, CTA 0.838, color ultrasound combined with CTA AUC analysis showed that 0.833; Compared with DSA, color Doppler ultrasound (P=0.027), CTA (P=0.041) with statistically significant difference, no statistical significance of color Doppler ultrasound combined with CTA examination and the difference of DSA (P=0.442).2. with carotid artery ultrasound detected plaque as the reference standard, the sensitivity of carotid artery plaque: CTA90.4%, DSA71.1%; specificity: CTA96.3% DSA, 98.5%; accurate degree: CTA92.9%, DSA 77.3%; the rate of misdiagnosis: CTA9.6%, DSA 28.9%; the misdiagnosis rate: CTA3.7%, DSA 1.5%; CTA0.867, DSA0.696; Youden index: positive likelihood ratio: CTA 24.4324, DSA47.4:, CTA0.0997, negative likelihood ratio DSA0.2934; X 2:CTA144.34, DsA103.22; P value: CTA0.057, DSA0.000; K:CTA0.855, DSA area 0.519:ROC under the curve: CTA0.925, DSA0.747.AUC and CTA analysis showed that the carotid artery color Doppler ultrasound compared with no significant difference (P=0.057), DSA and carotid ultrasonography compared with significant statistical difference (P0.01). Conclusion: in the evaluation of carotid Arterial stenosis and non invasive method, color Doppler ultrasonography combined with CTA examination method is more accurate, slightly better than the single CTA (86.2%vs83.4%), far better than the single carotid artery ultrasonography (86.2%vs75.3%). Compared with DSA, color consistency, high color Doppler ultrasound combined with CTA consistency, combined examination of early screening of carotid artery in the evaluation method. The stenosis of carotid artery atherosclerotic plaque, accuracy of CTA examination is far better than that of DSA (92.9%vs77.3%).CTA and color Doppler ultrasound, consistent.CTA results can be used as an important method to evaluate the neck vascular lesions.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R743.3

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