关键词:

颈动脉狭窄, 动脉血管超声, CT血管成像, 诊断

Abstract:

Objective　To analyze and explore the reasons for the inconsistency between carotid vascular ultrasound and computed tomography angiography (CTA) in the diagnosis of carotid artery stenosis. Methods　A retrospective analysis was performed on 53 patients who underwent carotid vascular ultrasound and CTA in the Third Affiliated Hospital of Guangzhou Medical University from January 2018 to October 2022. There were 39 males and 14 females, aged (74.70±9.31) years. The internal carotid artery (ICA) and common carotid artery (CCA) blood vessels were recorded under carotid vascular ultrasound and CTA, with a total of 212 blood vessels. Whether the diagnosis results of carotid vascular ultrasound and CTA were consistent, and whether there were differences in the detection rate of stenosis and the degree of stenosis detected between the two test methods were analyzed. Statistical methods used were χ² test and Kappa consistency test. Results　There was a statistically significant difference in the detection rate of carotid artery stenosis between carotid vascular ultrasound and CTA (χ²=33.71, P<0.001). There was no statistically significant difference in the detection of CCA stenosis between the two detection methods (χ²=2.80, P>0.05), but there was a statistically significant difference in the detection of ICA stenosis between the two detection methods (χ²=11.98, P<0.05). There was no statistically significant difference in the detection of severe stenosis and occlusion of CCA between the two detection methods (χ²=0.70, P>0.05), but there was a statistically significant difference in the detection of severe stenosis and occlusion of ICA between the two detection methods (χ²=43.19, P<0.05). Taking CTA as the gold standard, the sensitivity, specificity, misdiagnosis rate, and missed diagnosis rate of carotid artery ultrasound for detecting moderate and severe carotid artery stenosis were 78.79%, 90.50%, 9.50%, and 21.21%, respectively. The accuracy rates of carotid artery ultrasound in the diagnosis of mild stenosis, moderate stenosis, severe stenosis, complete occlusion, and no stenosis of the carotid artery were 1.5%, 46.9%, 78.6%, 80.0%, and 87.5%, respectively. Carotid vascular ultrasound was consistent with CTA in the diagnosis of degree of carotid artery stenosis (Kappa=0.335, P<0.05). Conclusions　As the preferred test for clinical screening of carotid artery stenosis, the degree of carotid artery stenosis diagnosed by carotid vascular ultrasound is consistent with CTA. Ultrasound and CTA are consistent in detecting severe stenosis and occlusion of CCA. In the detection of mild carotid artery stenosis, there is a difference between ultrasound and CTA, mainly reflecting in a lower detection rate of ultrasound for mild stenosis lesions. Therefore, sonographers should strengthen the study of vascular ultrasound guidelines, skillfully adjust the relevant parameters of used instruments, further improve the accuracy of clinical diagnosis, and provide a stronger basis for the diagnosis and treatment for patients with carotid artery stenosis.

Key words:

Carotid artery stenosis, Carotid vascular ultrasound, Computed tomography angiography, Diagnosis