计算机断层扫描血管造影和数字减影血管造影在主动脉夹层诊断及术前评估中的应用比较

Comparison betweeen computed tomography angiography and digital subtraction angiography in terms of the diagnosis and pre-operative evaluation of aortic dissection

目的探讨计算机断层扫描血管造影(CTA)和数字减影血管造影(DSA)在主动脉夹层(AD)的诊断及术前评估的作用及一致性。方法回顾性分析60例AD患者的临床资料,比较CTA及DSA两种检查方法显示的AD破口近侧锚定区的距离、左锁骨下动脉左侧平面胸主动脉直径、主动脉夹层累及的范围及主动脉主要分支血管的累及情况。结果 60例患者均同期行CTA、DSA检查,CTA、DSA检查破口近端锚定区的距离大于或等于15mm者分别为44例(44/51,86.2%)、46例(46/56,82.1%);小于15mm者分别为7例(7/51,13.7%)、10例(10/56,17.8%),两种方法比较差异无统计学意义。CTA发现夹层累及左髂动脉(LIA)36例(36/60,60.0%)、累及右髂动脉(RIA)28例(28/60,46.7%),DSA仅发现夹层累及LIA14例(14/60,23.0%)、累及RIA13例(13/60,21.7%),两种方法比较差异有统计学意义(P=0.012,P=0.022);CTA、DSA在显示左锁骨下动脉左侧胸主动脉直径及内脏动脉受累情况比较差异无统计学意义。结论 CTA、DSA两种检查方法有较好的一致性,CTA因其无创性在EVAR术前评估中有重要价值。

Objective To compare computed tomography angiography (CTA) with digital subtraction angiography (DSA) in diagnosis and pre-operative evaluation of aortic dissection(AD). Methods The data of sixty patients with AD who were examined by both CTA and DSA were analyzed retrospectively. Some outcomes, including the anchoring distance proximal to the intimal tear, the aortic diameter of the left side of the left subclavian artery(LSA), the extent of AD and involvement of main aortic branches, were compared between CTA and DSA. Results The anchoring distance more than 15 mm from the tears to the origin of the LSA was found in 44 (44/51, 86.2%) and 46(46/56,82.1%)cases by CTA and DSA, respectively, and anchoring distance less than 15 mm in 7(7/51,13.7%) by CTA and 10(10/56,17.8%) by DSA,respectiely. There were no significant distances in anchoring distance between CTA and DSA (P>0.05). Involvement of the left iliac artery (LIA) and the right iliac artery (RIA) was found in 36 cases (36/60,60.0%) and 28 cases(28/60,46.7%) by CTA, and only in 14 cases (14/60,23.0%) and 13 cases(13/60,21.7%) by DSA, respectively, and there were statistical differences(P=0.012,P=0.022). There were no statistical differences in the aortic diameter of the left side of the LSA and involvement of visceral arteries detected by between CTA and DSA. Conclusion The two methods (CTA, DSA) are coincident with each other. Because of non-invasion, CTA has significant value for pre-operative evaluation before endovascular aortic repair.