目的 分析64排多层螺旋CT重 建技术(VR、MIP)及多普勒超声在诊断 颈内动脉狭窄程度中的作用。方法 选 取我院2014年3月-2016年3月期间收治 的临床高度怀疑有颈内动脉狭窄病变的 72例缺血性脑血管患者为研究对象，7d 内同时行CT血管造影(CTA)与多普勒超 声检查，CTA图像重建方法包括最大密 度投影(MIP)、容积再现(VR)，并行数 字减影血管造影(DSA)检查为金标准对 照。结果 72例患者中有44例患者62支 颈内动脉管壁表现为不同程度的钙化， MIP、VR检查均能显示钙化的部位和形 态；与轴位图像比较，MIP图像可见3支 颈动脉管壁钙化未显示，差异无统计学 意义(P＞0.05)，VR图像可见13支颈动脉 管壁钙化未显示，差异具有统计学意义 (P＜0.05)。72例患者281个节段经DSA确 诊209段血管可见不同程度狭窄，轻度、 中度、重度狭窄分别为61段、56段、49 段和完全闭塞43段。CTA轻度、中度、 重度狭窄及完全闭塞诊断准确率依次为 100%、96.42%、96.08%、100%均略高于 多普勒超声检查诊断96.83%、98.21%、 94.23%、90.70%，但差异无统计学意义 (P＞0.05)。结论 64排多层螺旋CT重建 技术比多普勒超声诊断颈内动脉狭窄程 度准确率略高，并能很好的显示血管钙 化情况，二者可通过血流色彩及血流狭 窄直径联合诊断颈内动脉狭窄程度。

Objective To analyze the effects of 64 slice spiral CT reconstruction techniques (VR, MIP) and Doppler ultrasound in the diagnosis of the degree of internal carotid artery stenosis. Methods Seventy-two patients with ischemic cerebrovascular diseases and clinically highly suspected internal carotid artery stenosis who were treated in our hospital between March 2014 and March 2016 were selected as study subjects. CT angiography (CTA) and Doppler ultrasound were performed at the same time within 7 days. The image reconstruction methods of CTA included maximum intensity projection (MIP) and volume rendering (VR), and digital subtraction angiography (DSA) was taken as the gold standard control. Results Among 72 patients, there were 44 patients (walls of 62 internal carotid arteries) with different degrees of calcification, and both of MIP and VR examination can show the site and shape of calcification. Compared with axial images, MIP images showed that calcification in walls of 3 carotid arteries was not displayed (P >0.05) while VR images showed 13 such carotid arteries (P<0.05). In 281 segments of 72 patients, 209 segments were confirmed by DSA, showing different degrees of vascular stenosis. There were mild, moderate and severe stenosis in 61 segment, 56 segments and 49 segments respectively, and 43 segments were with total occlusion. The accuracy rates of CTA in the diagnosis of mild, moderate and severe stenosis and total occlusion (100%, 96.42%, 96.08%, 100%) were slightly higher than those of Doppler ultrasound (96.83, 98.21%, 94.23%, 90.70%) (P>0.05). Conclusion The accuracy rates of 64 slice spiral CT reconstruction techniques are slightly higher than Doppler ultrasound in the diagnosis of the degree of internal carotid artery stenosis. It also can well display angiosteosis. The two can diagnose the degree of internal carotid artery stenosis by combining color of blood flow and diameter of blood flow stenosis.