螺旋CT血管成像对主动脉夹层的诊断

Diagnosis of aortic dissection using spiral computerized tomography angiography

目的评价螺旋CT血管成像(SCTA)对主动脉夹层的诊断价值方法回顾性分析经手术或DSA证实或与MRI、超声检查结合诊断的27例主动脉夹层患者的螺旋CT血管成像资料。SCTA技术包括二维横断面图像最大密度投影、多平面重建及CT仿真内窥镜图像。影像分析包括观察内膜破口的位置、夹层的范围、分支血管受累情况等。结果SCTA显示双腔主动脉和内膜片27例(100%),主动脉内膜钙化内移11例(40.7%),内膜破口22例(84.6%),DeBakeyⅠ型及Ⅱ型AD显示破口5例(55.56%)DeBakeyⅢ型显示破口17例(100%)28支分支血管受累。SCTA对2例被膜支架介入治疗后患者随访,显示1例有内支架移位。结论SCTA对主动脉夹层的诊断和相关改变的评价是准确和可靠的,SCTA对Ⅲ型AD的诊断价值更优于Ⅰ型及Ⅱ型AD。

Objective To evaluate effectiveness of spiral computerized tomography angiography （SCTA） in diagnosing aortic dissection （AD）. Methods 27 cases with AD underwent SCTA scan. All cases were confirmed as AD by operation, DSA, MRI or ultrasound. The SCTA falls into 2D cross-section imaging, MIP, MPR and virtual endoscopy imaging. The followings were observed： site of intimal tear, spread of dissection, and involvement of blood vessels. Results SCTA images showed double-lumen and intimal flap in all 27 cases （100%）, inward shifting of calcified aortic intima in 11 cases （40.7%）, intimal tear in 22 cases （84.6%）, type Ⅰ and Ⅱ of DeBakey AD in 5 cases （55.56%）, type Ⅲ of DeBakey AD in 17 cases （17%）, and 28 branches were involved. Afollow-up conducted with SCTA against 2 cases that had been intervened with intimal stent showed that one of them had his stent shifted. Conclusion SCTA is precise and reliable in diagnosing AD and other relevant disorders, and it is more effective in diagnosis of type Ⅲ AD than diagnosis of type Ⅰ and Ⅱ.