64层螺旋CT血管成像技术在腹主动脉瘤诊断及术前评价中的临床应用价值

The Value of Sixty-four Slice Spiral CT Angiography in Diagnosing and Evaluating Abdominal Aortic Aneurysm before Operations

目的探讨64层螺旋CT血管成像技术在腹主动脉瘤(abdominal aortic aneurysm,AAA)诊断及术前评价中的临床应用价值。方法对43例临床怀疑为AAA的连续性患者进行了64层螺旋CT高浓度碘对比剂(370 mg I/mL)血管造影检查,其中38例诊断为AAA且图像质量满足诊断要求者被纳入研究。所有患者的图像重建及分析工作均在工作站上完成,重建技术包括多平面重建(MPR)、最大强度投影(MIP)及容积显示技术(VRT)。在全面观察分析图像的基础上,重点观察AAA的类型、部位、大小、累及范围,并按照腔内隔绝术的要求对AAA进行相关参数测量并分型。结果①38例AAA均位于肾动脉平面下方,6例为近肾型、32例为肾下型。②依据腔内隔绝术的要求,38例患者划分为Ⅰ型4例、ⅡA型3例、ⅡB型4例、ⅡC型21例、Ⅲ型6例。③64层螺旋CT血管造影术(CTA)图像能清晰显示所有患者瘤体的形态、部位、大小,与主动脉重要分支血管的关系及附壁血栓,能准确测量AAA的相关数据。结论64层螺旋CTA具有无创、快速、准确性高等优点,是AAA诊断及术前评价首选的影像学检查方法之一。

Objective To assess the value of sixty-four slice spiral CT angiography（CTA） in diagnosing and evaluating abdominal aortic aneurysm（AAA） before operations.Methods Between Oct 2006 and Jan 2008,forty-three consecutive patients with suspected AAA underwent examinations by the sixty-four slice spiral CT angiography with 370 mg I/mL contrast material.Of these patients,38 patients whose AAA imaging quality met the diagnostic criteria were enrolled in the study.Imaging reconstruction were made at the workstation,which included multi-plane reconstruction（MPR）,maximum intensity projection（MIP） and volume rendering technique（VRT）.The comprehensive observation and analysis focused on the type,location,size and extension of AAA.The classification of AAA was based on the relevant parameters that satisfied the requirement of endovascular stent-graft exclusion.Results ① The aneurysms of all of the 38 patients were located at under the level of renal arteries,including six that were adjacent to renal arteries and 32 under renal arteries.② Among the 38 patients with AAA,4 were typeⅠ,3 were type ⅡA, 4 were type ⅡB,21 were type ⅡC,and 6 were type Ⅲ.③ The sixty-four slice spiral CT angiography clearly displayed the shape,locality and size of the aneurysms,the anatomic relations between the aneurismal bodies and the adjacent main branches of aorta,and the mural thrombus in all of the patients.Relevant parameters of AAA could be accurately measured by the CTA images.Conclusion Sixty-four slice spiral CT angiography is a fast,non-invasive and effective instrument for diagnosing and evaluating AAA before operations.