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目的探讨256iCT血管成像在下肢动脉支架植入术后支架内再狭窄的应用价值。方法对36例有临床症状的下肢动脉支架植入术后患者行256iCT下肢动脉增强扫描,将薄层轴位原始图像传入EBW工作站,运用曲面重组(curve plannar reconstruction,CPR)、多平面重组(multiplannar reconstruction,MPR)、最大密度投影(maximum intensity projection,MIP)、容积再现(volume rendering,VR)等后处理方法进行血管重组。所有患者在行CT扫描后1周内行数字减影血管造影(digital subtraction angiography,DSA)检查。以DSA结果为金标准,计算256iCT对支架内再狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果 36例患者共放置支架72枚,其中58枚(80.6%)支架显影良好可以评价。在可评价支架中,以DSA为诊断标准,血管重组图像结合原始轴位图像,256iCT血管成像诊断下肢动脉支架再狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为100%(27/27)、96.8%(30/31)、96.4%(27/28)、100%(30/30)、98.3%(57/58)。结论 256iCT下肢血管成像评价下肢动脉支架术后再狭窄的敏感性和准确性较高,可以作为下肢动脉支架术后怀疑支架内再狭窄患者的重要检查手段。
Objective To investigate the value of 256iCT angiography in the in-stent restenosis after lower extremity artery stent implantation. Methods Thirty-six patients with clinical symptoms of lower extremity artery stent implantation underwent 256iCT arterial enhancement scanning. The original axial slice images were sent to the EBW workstation and analyzed by curve plannar reconstruction (CPR), multiplanar reconstruction Multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendering (VR) were used to revascularize blood vessels. All patients underwent digital subtraction angiography (DSA) within 1 week after CT scan. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 256iCT for in-stent restenosis were calculated using the DSA results as the gold standard. Results Totally 72 stents were placed in 36 patients, of which 58 (80.6%) scaffolds developed well and could be evaluated. In the evaluable stents, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of reconstructed images with DSA as the diagnostic criteria, combined with original axial images and 256iCT angiography in the diagnosis of lower extremity arterial stent restenosis were 100 % (27/27), 96.8% (30/31), 96.4% (27/28), 100% (30/30), 98.3% (57/58). Conclusion The sensitivity and accuracy of 256iCT lower extremity vascular imaging in the evaluation of restenosis after lower extremity arterial stenting are high. It can be used as an important examination method in patients with suspected in-stent restenosis after lower extremity arterial stenting.