彩色室壁运动和定量分析软件观测腹主动脉瘤壁的节段运动

Segment movement of abdominal aorta aneurysmal wall:Observation by color kinesis and ICKTM Quantitative Analysis System

目的:运用彩色室壁运动定量分析正常腹主动脉壁及腹主动脉瘤患者瘤壁运动的可行性。方法:于2006-04/12选择解放军第二军医大学长海医院血管外科收治的肾动脉下型腹主动脉瘤患者10例,均为男性,预行腹主动脉瘤人工血管置换术或腔内隔绝术瘤体直径均大于4.5cm,为腹主动脉瘤组。同期选择健康体检年轻男性20例为正常年轻组和健康老年男性20例为正常老年组。3组受试者年龄、血压比较无显著差异,具有可比性。实验经医院伦理委员会批准,所有受试者均知情同意。使用彩色室壁运动技术对正常年轻组及正常老年组受试者肾动脉下腹主动脉壁运动和腹主动脉瘤组患者动脉瘤壁运动进行观测和记录,并使用定量分析软件(ICKTM)对所得图像加以分析。正常年轻组和正常老年组受检者均测量脐上1cm处腹主动脉的横及纵切面的动脉壁的运动参数。腹主动脉瘤组患者通过超声测量腹主动脉瘤入口、最大内径处和出口处的内径及壁厚。结果:①动脉壁位移幅度:正常年轻组、正常老年组、腹主动脉瘤组各点上的前壁位移均较后壁位移大(P<0.05)。正常老年组腹主动脉前壁位移距离较正常年轻组小(P<0.05),后壁位移距离与正常年轻组无显著差异(P>0.05)。腹主动脉瘤组前后壁的位移在入口、最大直径处、出口均较正常老年组前后壁位移小(P<0.05)。腹主动脉瘤入口处前壁和后壁的位移距离均较最大直径处和出口处大(P<0.05)。②正常腹主动脉和腹主动脉瘤壁的运动情况:正常年轻组腹主动脉壁的运动是基本对称和一致的,即在横切面上各节段是同时完成收缩和舒张的。腹主动脉瘤壁在横切面上的运动则失去了这种对称性和一致性,特别是在舒张期。正常年轻组纵切面,前壁位移幅度明显较后壁大,腹主动脉瘤组纵切面,后壁基本没有移动,前壁的位移也不均一。③定量分析软件(ICKTM)结果:正常腹主动脉壁各段的运动虽速度不一样,但基本是同时达到最大位移。腹主动脉瘤壁各段的运动不一致,完成位移的时间均不相同。结论:使用彩色室壁运动技术和定量分析软件(ICKTM)观测腹主动脉和腹主动脉瘤壁节段运动是可行的,可以对瘤壁运动提供更多的信息。

AIM： To analyze the feasibility of wall movement of infrarenal abdominal aorta and abdominal aortic aneurysm （AAA） by color kinesis （CK） and ICKTM Quantitative Analysis System. METHODS： Ten male patients with infrarenal AAA were enrolled from Department of Vascular Surgery, Changhai Hospital, Second Military Medical University of Chinese PLA from April to December 2006. Artificial vascular replacement or endovascular exclusion for AAA was pretreated in AAA patients as AAA group. The diameter of AAA was more than 4.5 cm. Twenty healthy males, who did body examination at the same time, were enrolled as normal youth group and twenty healthy older males were enrolled as normal elder group. No significant difference was found in age and blood pressure in testees of the three groups. The experiment was approved by Hospital Ethics Committee and all subjects signed in the informed consent. The wall movement of aortic artery or AAA was observed by CK in normal youth group, normal elder group and AAA group, and the image was analyzed with ICKTM Quantitative Analysis System. Diastolic and systolic color kinesis images were obtained in short-axis and long-axis views in the 1 cm upper hylus in the subjects of normal youth group and normal elder group. Inner diameter and depth of wall were determined in inlet, maximum diameter and outlet of subjects in the AAA group by ultrasonometry. RESULTS：①The wall displacement of aortic artery： The displacement of anterior wall was longer than that of posterior wall in the normal youth group, normal elder group and AAA group （P〈 0.05）. The displacement of anterior wall was shorter in the normal elder group than the normal youth group（P 〈 0.05）. No significant difference in the displacement of posterior wall was found compared with the normal youth group （P 〉 0.05）. The displacement of anterior or posterior wall was shorter in inlet, maximum diameter and outlet of subjects of the AAA group than the normal elder group（ P 〈 0.05 ）. The displacement of anterior or posterior wall was longer in the inlet of subjects than in the maximum diameter and outlet of subjects of the AAA group （P 〈 0.05）. ② Wall movement of infrarenal abdominal aorta and AAA： In cross-section, the movement of aortic wall in difference segment was concordant and symmetrical basically in the normal youth group, namely diastole and systole were performed at the same time, but the characteristics were vanished in aneurysmatic wall especially in diastolic phase. In longitudinal section, the displacement of anterior wall was longer than that of posterior wall in the normal youth group, but posterior wall did not move and anterior wall moved irregularly in the AAA group. ③ICKTM results： Movement speed of normal abdominal aortic wall was different in each section, but most reached the maximal displacement at the same time. Displacement was different in each sections of AAA wall, and finished time of displacement was also different. CONCLUSION： It is feasible to observe wall movement of abdominal aorta and AAA with CK and ICKTM Quantitative Analysis System that can offer more information of AAA wall movement.