64排CTA在主动脉夹层DeBakeyⅠ-Ⅲ型中的诊断价值研究

Study on the Diagnostic Value of 64-slice CT in Type De Bakey I- III Aortic Dissection

目的研究64排CT血管成像在主动脉夹层De BakeyⅠ-Ⅲ型中的诊断和临床治疗中的应用价值。方法以我院2013年2月-2015年2月经手术或DSA证实的40例主动脉夹层患者进行回顾性分析,结合MSCT平扫及增强检查,在后处理工作站行多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、容积再现(VR)重建。结果40例患者中,I型10例(25.0%),II型3例(7.5%),III型27例(67.5%)。64层螺旋CT诊断AD的特异度和敏感度均为100%。MPR和CPR对破口、真假腔及内膜瓣显示率分别为95.9%、100%。结论 64排MSCT检查对主动脉夹层De Bakey分型快速、准确,能够清晰显示主动脉全程及分支变异、内膜瓣、破口、真假腔、剥离范围、分支血管受累、心包填塞等情况有重要的诊断价值,并可对各种急性胸主动脉疾病如心肌梗死、冠心病、肺动脉栓塞及时排除,是主动脉夹层临床诊断的首选和可靠的检查方法。

Objective To study the diagnostic value of 64-slice CT in type DeBakey I - III aortic dissection.Methods 40 cases of patients with aortic dissection confirmed by pathology or DSA admitted into the hospital from February 2013 to February 2015 were selected as the research object and all received 64-slice CT scan. The image data was processed by 3D reconstruction and the CT imaging features were analyzed.Results There were 10 cases （25%） of type I, 3 cases （7.5%） of type II and 27 cases （67.5%） of type III. True lumen was mainly circular, accounting for 75.0% while false lumen mainly was crescent shaped, accounting for 75.0%. Intimal tears located in the proximal descending aorta accounted for 42.5%, in ascending aorta for 32.5% and 10% without show. CT scan： there was 4 cases of false lumen of high density and 7 cases of intimal calcification calcified plaque ingression; enhanced scanning： there were 17 cases of true and false lumen in arterial phase significantly enhanced and the enhancement degree of true lumen was of 19 cases greater than that of the false lumen; In venous phase, the density of false lumen was of34 cases greater than that of the true lumen. There were 2 cases of rue and false lumen with the same density; In addition, there were 4 cases of false lumen without enhancement or small pieces with enhancement.Conclusion 64-slice spiral CT is of important diagnostic value in aortic dissection DeBakey typing, identification of true and false cavity and crevasse display. It is worth further application in the clinical diagnosis of aortic dissection.