640层容积CT对StanfordB型主动脉夹层腔内隔绝术后随访的应用价值

Clinical application of 640-slice volume CT angiography in follow-up observation of Stanford B type aortic dissection after endovascular exclusion

目的探讨640层容积CT对主动脉夹层腔内隔绝术治疗后的影像学特征及其术后评价价值。方法回顾性分析53例主动脉夹层患者经外科治疗后的640层容积CT成像检査资料,所有患者的图像分析及后处理工作均在Vitrea后处理工作站上完成,重建方法包括多平面重建(MPR)、最大密度投影法(MIP)、容积再现(VR)技术等多种后处理方法。重点观察与分析支架的位置、支架有无内漏及假腔情况。结果 53例均可清楚显示支架位置、形态、个数、对假腔的封闭情况。术后恢复良好45例,其中37例降主动脉夹层内有血栓形成,8例降主动脉夹层内有部分血栓形成。术后发生支架内漏8例,Ⅰ型内漏6例,Ⅲ型内漏2例。结论 640层CT血管造影是一种方便、快捷和无创的检查手段,综合原始及各种后处理图像可以准确诊断并客观地评价主动脉夹层术后情况,是主动脉夹层术后诊断及随访的重要影像检査方法之一。

Objective To explore the imaging features of Stanford B type aortic dissection after endovascular exclusion on 640-slice volume CT scans and to discuss the application of 640-slice volume CT angiography in evaluating the therapeutic results. Methods A total of 53 cases with Stanford B type aortic dissection were enrolled in this study. After endovascular exclusion, 640-slice volume CT angiography was performed in all patients. The imaging data were retrospectively analyzed. The image analysis and the post- processing work were completed on a Vitrea workstation. The reconstruction techniques included multiple planar reconstruction （MPR）, maximum intensity projection （MIP）, volume rendering （VR）, etc. The observation was focused on the stent location, in-stent leakage, false lumen, etc. The results were analyzed. Results The position, shape and number of the stents as well as the sealing off condition of the false lumen were clearly shown in all 53 patients. Excellent postoperative recovery was obtained in 45 cases, among them complete thrombosis within the dissecting aneurysm of the descending aorta was seen in 37 cases and partial thrombosis in 8 cases. After the operation, in-stent leakage was detected in 8 cases, including type I leakage （n = 6） and type 11I leakage （n = 2）. Conclusion The performance of 640-slice volume CT angiography is convenient, fast and non-invasive. Based on the combination analysis of original and reconstructed images Stanford B type aortic dissection can be correctly diagnosed and the clinical efficacy of endovascular exclusion can be objectively evaluated. Therefore, 640-slice volume CT angiography is an important diagnostic means for Stanford B type aortic dissection.