对MRA诊断主动脉夹层动脉瘤的评价(附136例报告)

Evaluation of MRA in aortic dissection diagnosis-comparison of MRA findings with the operative discovery in 136 patients

目的探讨MRA诊断主动脉夹层动脉瘤的价值。方法2000年10月至2002年12月,136例患主动脉疾病的病人术前经trueFISP3DCEMRA影像学检查,并与术中主动脉病理改变进行对比研究。病人男116例,女20例;平均年龄(45.5±12.2)岁。分为主动脉夹层动脉瘤组108例,急诊发病(发病时间小于2周)76例,包括I型夹层动脉瘤41例,II型夹层动脉瘤9例,IIIA夹层动脉瘤1例,IIIB夹层动脉瘤57例;非夹层动脉瘤组28例,包括升主动脉瘤9例,马方根部瘤6例,降主动脉脉假性动脉瘤5例,降主动脉瘤4例,升主动脉假动脉瘤、降主动脉缩窄、弓部瘤、弓部假性动脉瘤各1例。结果术前MRA诊断与术中所见对比显示,MRA对主动脉夹层动脉瘤及其累及范围诊断的敏感性及特异性均为100%;撕裂位置诊断的敏感性为85.2%,特异性100%;头臂干受累情况诊断的敏感性为90.3%,特异性为100%;心包及胸腔积液诊断的敏感性及特异性均为100%;假腔内血流情况诊断的敏感性为98.1%,特异性为100%。结论trueFISP3DCEMRA技术对主动脉夹层动脉瘤的诊断安全、可靠,基本可取代常规血管造影,被视为主动脉夹层动脉瘤和其他主动脉疾病诊断的“金标准”。

Objective To evaluate MRA in diagnosis of aortic dissection. Methods From October 2000 to December 2002, 136 patients （Male/Female, 116/20 ） suspected aortic disease were examined with true FISP 3D CE MRA before operation, and the results were compared with the pathological change during operation. The average age was （45.5±12.2） years （ 12±70 yeats）. They we,re divided in two groups： Aortic dissection group （group Ⅰ）, 108 patients including DeBakey type 1 41 eases, DeBakey type Ⅱ 9 cases, DeBakey type Ⅲ 57 cases, and 76 patients emergency within 2 weeks after the initial onset of symptoms. Non aortic dissection group （group Ⅱ） , 28 patients including Marfan＇s aneuryam 6 cases, ascending aortic aneurysm 9 cases, ascending aortic pseudo aneurysm 1 case, arch aneurysm 1 case, descending aortic aneurysm 4 cases, descending aortic pseudo aneurysm 5 cases, aneutysm caused by aortic coarctation 1 cose, arch pseudo aneurysm 1 case. Results The diagnogis of MRA was the same with the discovery in the operation. Both the sensitivity and the specificity of the presence and the differentiation of aortic dissection were 100%. The sensitivity was as followed： the localization of intimal tears was 85.2% ; the involvement of arch branches was 90.3% ; the blood extravasation was 100% ; the blood flow of the false lumen was 98.1% ; but the specificity of all was 100%. Conclusion Tree FISP 3D CE MRA is safe and reliable method to diagnose aortic dissection. It seems capable to replace the aortic angiography. It is considered as the golden criteria for aortic dissection and other aortic diseases.