Imaging value of 64-slice CT angiography and digital subtraction angiography in lower limb arteriosclerosis obliterans in diabetic patients
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摘要:
目的 分析64层CT血管成像(64-CTA)与数字减影血管造影(DSA)在糖尿病患者下肢动脉硬化闭塞症中的影像学价值。 方法 收集2019年5月~2021年5月在我院确诊为糖尿病下肢动脉下肢动脉闭塞症的200例患者的64-CTA及DSA的资料，所有患者均先行64-CTA检查，24 h后行DSA检查，两种检查间隔均不超过2周。以DSA为金标准，计算64-CTA诊断糖尿病下肢动脉硬化闭塞症的敏感度、特异性、准确度、阳性预测值、阴性预测值，并计算64-CTA三种处理方式诊断符合率。 结果 200例患者中有64-CTA与DSA对照的共2265节段，以DSA为金标准，64-CTA发现有2115个节段与DSA一致，诊断符合率为93.38%。64-CTA高估1级共86节段，低估1级共53节段，绘制64-CTA与DSA显示下肢动脉狭窄分级节段分布曲线图，Kappa一致性检验结果显示Kappa值=0.915(P < 0.01)。以DSA为金标准，64-CTA诊断糖尿病下肢动脉硬化闭塞症有狭窄的敏感度为97.27%、特异性为98.17%、准确度为97.62%、阳性预测值为98.83%、阴性预测值为95.76%，对各个诊断界点的诊断效能均较高。以DSA为金标准，64-CTA-MIP符合率为88.74%，64-CTA-MPR符合率为92.98%，64-CTA-VR符合率为88.74%，64-CTA-MIP、64-CTA-VR诊断符合率明显低于64-CTA(P < 0.05)。病例图像分析发现64-CTA显示的狭窄程度较DSA更接近真实情况。 结论 64-CTA可准确显示糖尿病下肢动脉硬化闭塞症的狭窄程度，与DSA检查一致性较高，可作为该疾病的首要筛选检查方法。 Abstract:Objective To analyze the imaging value of 64-slice CT angiography (64-CTA) and digital subtraction angiography (DSA) in lower limb arteriosclerosis obliterans in diabetic patients. Methods The data of 64-CTA and DSA of 200 patients with diabetic lower limb arterial occlusive disease diagnosed in our hospital from May 2019 to May 2021 were collected. All patients underwent 64-CTA examination, and DSA examination was performed after 24 h. The interval between the two examinations was not more than 2 weeks. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 64-CTA in the diagnosis of diabetic lower extremity arteriosclerosis obliterans were calculated using DSA as the gold standard. The diagnostic coincidence rates of the three treatment methods of 64-CTA were calculated. Results A total of 2265 segments of 200 patients were compared between 64-CTA and DSA. Taking DSA as the gold standard, 2115 segments of 64-CTA were consistent with DSA, with a diagnostic coincidence rate of 93.38%. 64-CTA overestimated grade 1 by 86 times and underestimated grade 1 by 53 times. The distribution curve of 64-CTA and DSA showing the grade of lower limb arterial stenosis was drawn. The results of kappa agreement test showed that the kappa value=0.915 (P < 0.01). Taking DSA as the gold standard, 64-CTA had a sensitivity of 97.27%, specificity of 98.17%, accuracy of 97.62%, positive predictive value of 98.83% and negative predictive value of 95.76% for diagnosing diabetic lower extremity arteriosclerosis obliterans, with a high diagnostic efficacy for each diagnostic cut-off point. The coincidence rate of 64-CTA-MIP was 88.74%, the coincidence rate of 64-CTA-MPR was 92.98%, and the coincidence rate of 64-CTA-VR was 88.74%, and the diagnostic coincidence rate of 64-CTA-MIP and 64-CTA-VR was significantly lower than that of 64-CTA (P < 0.05). Image analysis showed that the degree of stenosis displayed by 64-CTA was closer to the true situation than that of DSA. Conclusion 64-CTA can accurately show the degree of stenosis in diabetic lower extremity arteriosclerosis obliterans, with high consistency with DSA examination. -
图 1 64-CTA与DSA显示下肢动脉狭窄分级节段分布图
Figure 1. Graded segmental distribution of lower extremity arterial stenosis on 64-CTA and DSA.
图 2 64-CTA与DSA检查病例图像
患者女，确诊糖尿病11年。A：小腿血管CTA-VR重建；B：CT-MPR斜矢状位重建；图A、C：小腿同一节段血管病变，显示：胫前动脉起始段、中段血管中度狭窄（箭头）；D：同一患者股浅动脉DSA造影，显示股浅动脉轻度狭窄（箭头）.
Figure 2. 64-CTA and DSA examination case imagings.
表 1 64-CTA与DSA显示下肢动脉狭窄分级节段数比较
Table 1. Comparison of the number of graded segments of lower extremity arterial stenosis by 64-CTA and DSA (n)
64-CTA DSA 正常 轻度狭窄 中度狭窄 重度狭窄 闭塞 合计 正常 594 11 0 0 0 605 轻度狭窄 16 419 26 0 0 461 中度狭窄 0 16 302 27 0 345 重度狭窄 0 0 27 535 0 562 闭塞 0 0 0 27 265 292 合计 610 446 355 589 265 2265 64-CTA：64层CT血管成像；DSA：数字减影血管造影. 
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表 2 64-CTA诊断糖尿病下肢动脉狭窄的效率
Table 2. Efficiency of 64-CTA in diagnosing diabetic lower extremity arterial stenosis
诊断界点 诊断效能(%) 敏感度 特异性 准确度 阳性预测值 阴性预测值 有狭窄 97.27 98.17 97.62 98.83 95.76 轻度狭窄 90.89 98.50 96.95 93.95 97.69 中度狭窄 87.53 97.24 95.76 85.07 97.75 重度狭窄 90.83 98.39 96.42 95.20 96.83 有闭塞 100.00 98.65 98.81 90.75 100.00
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表 3 64-CTA三种处理方式诊断符合率比较
Table 3. Comparison of the diagnostic compliance rate of the three treatments of 64-CTA
检杳方式 例数 与DSA符合 符合率(%) χ2 P 64-CTA 2265 2115 93.38 64-CTA-MIP 2265 2010 88.74 29.895 < 0.001 64-CTA-MPR 2265 2106 92.98 0.281 0.596 64-CTA-VR 2265 2010 88.74 29.895 < 0.001
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