CAJ | 학술논문

目的评价X线平片检测维持性血液透析(MHD)患者动脉钙化的敏感性和特异性.方法 54例MHD患者行腹部-股骨上1/3多层螺旋CT(MSCT)平扫及侧位腹平片、骨盆片X线榆测.以腰椎(L)2～3间隙为界将腹主动脉分为上段、下段.MSCT结果据钙化严重程度分为0～5级.两位放射科医师分别盲法阅片诊断.以MSCT结果为金标准,X线平片结果作为诊断性指标,评价X线平片诊断腹主动脉和髂、股动脉钙化的敏感性和特异性.结果 MSCT结果显示,腹主动脉钙化发生率为86.1%,髂、股动脉钙化发生率为74.5%,二者差异有统计学意义(X2=5.695,P=0.017);腹主动脉2级以上钙化的发生率为60.2%,髂、股动脉为42.6%,腹主动脉钙化的严重程度显著高于髂、股动脉(X2=8.922,P=0.003).X线平片结果表明,腹主动脉钙化发生率为51.9%,髂、股动脉钙化发生率为18.5%.X线平片诊断腹主动脉和髂、股动脉钙化的特异性均为100%,敏感性随MSCT动脉钙化程度的加重而增高.据MSCT钙化评分的不同,其诊断腹主动脉和髂、股动脉钙化的敏感性分别如下:≥1级:60.2%和24.8%;≥2级:76.9%和43.5%;≥3级:100%和74.4%.结论 X线平片诊断中、重度动脉钙化敏感性高,诊断腹主动脉钙化的敏感度高于髂、股动脉,可用于MHD患者中、重度动脉钙化的检测.
목적 평개X선평편검측유지성혈액투석(MHD)환자동맥개화적민감성화특이성.방법 54례MHD환자행복부-고골상1/3다층라선CT(MSCT)평소급측위복평편、골분편X선유측.이요추(L)2～3간극위계장복주동맥분위상단、하단.MSCT결과거개화엄중정도분위0～5급.량위방사과의사분별맹법열편진단.이MSCT결과위금표준,X선평편결과작위진단성지표,평개X선평편진단복주동맥화가、고동맥개화적민감성화특이성.결과 MSCT결과현시,복주동맥개화발생솔위86.1%,가、고동맥개화발생솔위74.5%,이자차이유통계학의의(X2=5.695,P=0.017);복주동맥2급이상개화적발생솔위60.2%,가、고동맥위42.6%,복주동맥개화적엄중정도현저고우가、고동맥(X2=8.922,P=0.003).X선평편결과표명,복주동맥개화발생솔위51.9%,가、고동맥개화발생솔위18.5%.X선평편진단복주동맥화가、고동맥개화적특이성균위100%,민감성수MSCT동맥개화정도적가중이증고.거MSCT개화평분적불동,기진단복주동맥화가、고동맥개화적민감성분별여하:≥1급:60.2%화24.8%;≥2급:76.9%화43.5%;≥3급:100%화74.4%.결론 X선평편진단중、중도동맥개화민감성고,진단복주동맥개화적민감도고우가、고동맥,가용우MHD환자중、중도동맥개화적검측.
Objective To evaluate the sensitivity and specificity of plain radiography in the diagnosis of vascular calcification in maintenance hemodialysis (MHD) patients. Methods Multi-slice computed tomography (MSCT) was used as the reference standard in the assessment of vascular calcification in MHD patients. A total of 54 MHD patients, 26 male and 28 female, mean age (60.4±13.3) years, underwent both MSCT and plain radiography of lateral abdomen and pelvis to evaluate abdominal aortic calcification, bilateral iliac and femoral artery calcification. Abdominal aorta was divided into upper and lower segment by L2-L3 intervertebral space. The severity of vascular calcification by MSCT was graded from score 0 to 5. Two independent radiologists analyzed the results of plain radiography and MSCT, and inter-observer agreements were calculated by using K statistics. Results According to the results of MSCT, the calcification rate of abdominal aorta was 86.1%, and the calcification rate of iliac and femoral artery was 74.5%. There was significant difference of the calcification rate between large artery and muscular arteries. Inter-observer agreement of calcification was excellent (K =0.864-0.893). Compared with MSCT, the specificity of plain radiography with regard to detection of abdominal aortic, iliac and femoral calcification were 100%. The sensitivity of plain radiography was different according to the different MSCT score, which was as follows: MSCT score ≥ grade 1: 60.2% and 24.8% for lateral abdomen radiography to detect abdominal aortic calcification and pelvic radiography to detect iliac, femoral calcification respectively; MSCT score ≥ grade 2: 76.9% and 43.5% respectively; MSCT score grade 3: 100% and 74.4% respectively. Conclusions The sensitivity of plain radiography in the assessment of vascular calcification increases with the severity of calcification. The sensitivity in the assessment of abdominal aortic calcification is higher than that of iliac and femoral artery calcification. Plain radiography can be used to detect moderate to severe vascular calcification in MHD patients.