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脑卒中已经成为中国人十大死亡原因之首[1]。研究[2]认为脑卒中的风险随着颈动脉粥样硬化斑块的增加而增加,因此对于颈动脉钙化的检出和评价非常重要。冠状动脉Agatston钙化评分是一个公认的诊断工具,研究[3]证实动脉粥样硬化程度和未来心血管疾病的风险具有相关性。类似的评分方式也可以用于颈动脉钙化的评价中。既往有研究[4]显示,在CT血管造影中,颈内动脉钙化体积的不同阈值能够判断其狭窄情况。但是,高密度造影剂的存在可能会干扰钙化体积的测量。随着医学影像技术的进展,螺旋CT薄层扫描即使是普通的平扫也能清晰显示血管内的钙化情况[5]。为此,本研究试图定量分析非增强CT中颈动脉分叉的钙化情况与数字减影血管造影(DSA)所明确的颈内动脉狭窄之间的关系,从而为中风的早期筛查提供基础。
颈动脉分叉非增强CT钙化体积与狭窄程度的相关性分析
Correlation analysis of calcification volume on non-enhanced CT and stenosis degree in carotid bifurcation
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摘要:
目的探讨颈动脉分叉非增强CT钙化体积与数字减影血管造影(DSA)中颈内动脉狭窄程度之间的相关性。 方法分析29例接受颈动脉扫描病人的影像资料,包括非增强CT和DSA两种扫描方式。CT图像中分割钙化斑块,三维重建软件测量体积;DSA评价颈内动脉的狭窄程度,>40%定义为“显著狭窄”。Pearson相关分析评价钙化体积和狭窄程度间的相关性,受试者特征曲线(ROC)评价钙化体积预测颈内动脉显著狭窄的价值。 结果29例病人颈动脉分叉的钙化体积为(0.17±0.10)cm3,25例(86.2%)有不同程度的狭窄,其中17例明显狭窄。相关性分析显示,非增强CT上的钙化体积与DSA中颈内动脉狭窄程度呈中度正相关(r=0.455,P < 0.05)。ROC曲线显示,钙化体积预测颈内动脉显著狭窄ROC曲线下Cut-off值为0.07 cm3,灵敏度为100.0%,特异度为66.7%,钙化体积预测颈内动脉显著狭窄的ROC曲线下面积为0.799(P < 0.01)。 结论颈总动脉分叉钙化体积与颈内动脉狭窄程度呈中度正相关,钙化体积超过0.07 cm3可作为预测颈内动脉显著狭窄的一个筛查指标。 Abstract:ObjectiveTo investigate the correlation between the calcification volume of carotid bifurcation on non-enhanced CT and the stenosis degree of internal carotid artery on digital subtraction angiography(DSA). MethodsThe imaging data of 29 patients with carotid artery scanning were retrospectively analyzed, including non-enhanced CT and DSA scanning.Calcified plaque of carotid bifurcation was segmented in CT image and volume was measured by 3D reconstruction software.The stenosis degree of internal carotid artery was evaluated by DSA, and the stenosis degree >40% was defined as "obvious stenosis".Pearson correlation analysis was used to analyze the correlation between calcification volume and stenosis degree.The ROC curve was used to evaluate the value of calcification volume and predict the obvious stenosis. ResultsThe calcification volume of carotid bifurcation was(0.17±0.10) cm3 in all 29 patients.Among them, 25 patients(86.2%) had stenosis of internal carotid artery with different degrees, in which 17 patients had obvious stenosis.Correlation analysis showed that the calcification volume on non-enhanced CT was moderately correlated with the carotid stenosis degree in DSA(r=0.455, P < 0.05).The ROC curve showed that the cut-off value of the calcification volume used to predict obvious stenosis was 0.07 cm3(P < 0.01) with the sensitivity of 100.0% and specificity of 66.7%. ConclusionsThe calcification volume of carotid bifurcation in non-enhanced CT is related to the stenosis degree of internal carotid artery.The volume over 0.07 cm3 can be used as a screening index to predict obvious stenosis. -
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