多层螺旋CT图像后处理软件OsiriX显示Adamkiewicz动脉及其在主动脉疾病腔内治疗中的应用研究

Demonstration of the Adamkiewicz artery and its application in the endovascular therapy of thoracoabdominal aortic disease

目的:探讨多层螺旋CT图像后处理软件OsiriX显示Adamkiewicz动脉(AKA)及其在主动脉疾病腔内治疗中的应用价值。方法:应用多层螺旋CT图像后处理软件OsiriX对34例经16层螺旋CT检查的胸腹主动脉疾病病人的DICOM源图像进行AKA定位显示,其中Stanford B型主动脉夹层21例,StanfordA型2例,胸腹主动脉瘤4例,降主动脉瘤6例,主动脉弓瘤1例。腔内修复术覆膜支架部分覆盖T8以远水平者11例。结果:29例病人共显示33支AKA,其中1级21例,2级8例,总显影率为85.3%。11例覆膜支架部分覆盖T8以远水平者术后随访均可见脊髓前动脉(ASA)及AKA显示,其中2例降主动脉瘤AKA起源的肋间动脉被覆盖,但ASA及AKA仍见清晰显影。结论:应用OsiriX软件行术前AKA定位,其结果可靠、可信,为临床外科医师独立完成此技术提供可能。AKA起源的肋间动脉被支架完全覆盖不一定会引发截瘫,但仍需进一步的大样本前瞻性研究来加以验证。

Objective To evaluate the role played by the Adamkiewicz artery （AKA） as shown by the multidetector CT scanning with OsiriX analysis software, and to reveal its relationship with postoperative paraplegia in the endovascular therapy of thoracoabdominal aortic diseases. Methods Muhidetector CT scanning was performed in 34 patients with thoracoabdominal aortic diseases to elucidate the AKA by using OsiriX which belonged to a sort of CT image analysis software. There were 21 cases of Stanford type B aortic dissection, 2 Stanford type A aortic dissection, and 4 thoracoabdominal aortic aneurysms, 6 descending thoracic aortic aneurysms, and 1 aortic arch aneurysm. Eleven patients underwent endovascular repair （EVR） with the distal thoracic aortic segment distaled to Ta needed to be partially excluded. Results Thirty-three AKA were identified in 29 of the 34 patients （85.3%）, with 21 cases belonging to Grade 1 and 8 to Grade 2. All the AKA and anterior spinal arteries were visualized in the follow-up CTA of the 11 patients undergoing EVR with distal thoracic aorta partially excluded, involving 2 distinct cases with desending thoracic aortic aneurysm whose AKA-originating intercostal artery were sealed after EVR. Conclusions Preoperative location of the AKA demonstrated by muhidetector CT scanning with OsiriX software is credible, giving the surgeons the possibility of accomplishing the proposed technique independently. It is uncertain if the AKA-originating intercostal artery sealed by the stent grafts may cause paraplegia; this would need larger sample prospective studies to elucide.