本文選題：CT血管成像 + 數(shù)字減影血管造影��； 參考：《山西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：下肢動脈閉塞癥在我國發(fā)病率越來越高，而下肢動脈粥樣硬化及糖尿病是其主要病因，它嚴(yán)重影響中老年人群的生活質(zhì)量，準(zhǔn)確的評估對于臨床治療方式的選擇至關(guān)重要。下肢動脈閉塞癥的影像學(xué)檢查方法很多，數(shù)字減影血管造影（DSA）被認(rèn)為是檢查下肢動脈閉塞癥的“金標(biāo)準(zhǔn)”，但它存在有創(chuàng)傷、有并發(fā)癥風(fēng)險等不足。自多層螺旋CT問世以來，由于其安全、快速、無創(chuàng)、準(zhǔn)確性高等特點，CT血管成像（CTA）已廣泛應(yīng)用于臨床�，F(xiàn)回顧性對比分析15例下肢動脈閉塞癥患者的CTA表現(xiàn)，全部患者2周內(nèi)行DSA檢查，探討CTA對該疾病診斷價值。 方法：收集臨床疑診下肢動脈閉塞癥患者15例，均行64排螺旋CTA掃描，并全部在兩周內(nèi)行雙下肢DSA檢查，將每位患者下肢血管分為22個解剖段（雙側(cè)髂總動脈、髂外動脈、髂內(nèi)動脈、股動脈、股淺動脈、股深動脈、乆動脈、脛前動脈、脛腓干、脛后動脈及腓動脈)，動脈狹窄程度分為正常、輕度（1%~49%）、中度（50%~74%）、重度（75%~99%）和閉塞五個級別，并以DSA為標(biāo)準(zhǔn)進(jìn)行對比，應(yīng)用SPSS17．0統(tǒng)計分析軟件，對DSA及CTA兩種檢查方法的結(jié)果進(jìn)行處理，得到雙向有序?qū)傩韵嗤牧新?lián)表資料分析，采用Kappa一致性檢驗法對CTA和DSA兩種獨立方法的評價結(jié)果進(jìn)行統(tǒng)計學(xué)處理得到Kappa值和P值，以“金標(biāo)準(zhǔn)”DSA作為對照，，評價CTA對下肢動脈閉塞癥診斷效能(靈敏度、特異度、準(zhǔn)確率、陽性預(yù)測值和陰性預(yù)測值)。 結(jié)果：CT血管成像（CTA）在下肢動脈閉塞癥狹窄分級的評估中，與“金標(biāo)準(zhǔn)”DSA對比一致性好，診斷效能高，輕度狹窄、中度狹窄、重度狹窄及完全閉塞的靈敏度分別為99.2%、97.5%、95.3%、100%，特異度分別為96.5%、96.1%、96.5%、98.7%，準(zhǔn)確度分別為98.2%、97.6%、96.2%、98.2%。 結(jié)論：1、CT血管成像（CTA）能精確評估下肢血管閉塞癥的狹窄程度，診斷效能可以媲美DSA。 2、CT血管成像（CTA）及其后處理是一種微創(chuàng)、快速、安全的檢查方法，可作為下肢動脈閉塞癥的首選篩查方法。
[Abstract]:Objective: the incidence of lower extremity arterial obliteration is increasing in China, and lower extremity atherosclerosis and diabetes mellitus are the main causes, which seriously affects the quality of life of middle and old people. Accurate evaluation is critical to the choice of clinical treatment. Digital subtraction angiography (DSAs) is considered to be the "golden standard" for the examination of lower extremity arterial occlusive disease, but it has many disadvantages, such as trauma, complication risk and so on. Since the advent of multislice spiral CT (MSCT), CT angiography has been widely used in clinic because of its safety, speed, noninvasive and high accuracy. The CTA findings of 15 patients with lower extremity arterial occlusive disease were analyzed retrospectively. All patients were examined with DSA within 2 weeks to explore the value of CTA in the diagnosis of the disease. Methods: a total of 15 patients with suspected lower extremity arterial obliteration were examined with 64-row spiral CTA, and each patient was divided into 22 anatomical segments (bilateral common iliac artery and external iliac artery) by DSA examination within two weeks. The internal iliac artery, the superficial femoral artery, the deep femoral artery, the tibiofibular trunk, the posterior tibial artery and the peroneal artery, the stenosis degree of the artery is divided into five grades: normal, mild and 49, moderate and 50. By comparing with DSA and using SPSS17.0 statistical analysis software, the results of DSA and CTA checking methods are processed, and the data of column table with the same bidirectional ordered attributes are obtained. The evaluation results of two independent methods, CTA and DSA, were statistically analyzed by Kappa consistency test to obtain Kappa value and P value. The diagnostic efficacy (sensitivity, specificity) of CTA for lower extremity arterial obliteration was evaluated with "golden standard" DSA as control. Accuracy, positive predictive value and negative predictive value. Results in the evaluation of stenosis grade of lower extremity arterial occlusive disease by using CT angiography, there was good consistency with "golden standard" DSA, and the diagnostic efficacy was high, mild stenosis and moderate stenosis. The sensitivity of severe stenosis and complete occlusion were 99.2 / 97.5 / 95.3 / 100, and the specificity were 96.5and 96.1/ 96.1/ 96.5, respectively. The accuracy was 98.2 / 97.6and 96.298.2respectively. ConclusionCTAA can accurately evaluate the degree of stenosis in lower extremity vascular obliteration, and its diagnostic efficacy is comparable to that of DSA. 2CT angiography (CTAA) and post-processing are a minimally invasive, rapid and safe method, which can be used as the first screening method for lower extremity arterial obliteration.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R816.2


本文編號：1903273