64排128层螺旋CT与1.5T MRI在主动脉夹层中的临床应用价值

Clinical value of 64 line 128 layer spiral CT and 1.5T MRI in aortic dissection

目的:探讨64排128层螺旋CT与1.5T MRI在主动脉夹层中的临床应用价值。方法:选择临床诊断为主动脉夹层的60例患者进行CT与MRI检查,其中30例CT检查、30例MRI检查。60例均经心血管造影(DSA)检查。以DSA诊断为标准,比较CT与MRI在主动脉夹层中的应用价值。结果:CT和MRI在主动脉夹层诊断、分型、真假腔辨别、内膜片确定上达100%诊断率。CT/DSA显示破口15/19处、再破口6/11处、血管分支受累44/45支、假腔附壁血栓22/0处、溃疡24/25处、主动脉壁钙化12/0处。MRI/DSA显示破口6/15处、再破口5/10处、血管分支受累24/39支、假腔附壁血栓20/0处、溃疡10/21处、主动脉壁钙化0/0处。另外CT血管成像显示主动脉壁内血肿2例,DSA未显示;MRI/DSA组未显示。CT禁忌证4例(碘过敏2例、肾功能低1例、不愿接受X射线辐射1例)选择MRI检查。MRI禁忌证5例(心脏起博器1例、动脉瘤夹1例、幽闭恐怖症1例、主动脉夹层支架植入术后复查2例)选择CT检查。结论:CT与MRI对主动脉夹层的诊断、分型均具有较高的敏感性、特异性和准确性,但在破口、再破口及分支血管受累显示方面有一定差异,在禁忌证方面亦有差别,可以优势互补,以提高在临床中的应用价值。

Objective：To explore the clinical value of 64 line 128layer spiral CT and 1.5T MRI in aortic dissection.Method：Sixty patients were diagnosed the aortic dissection by DSA.Among them,30 were detected by CT and another30 by MRI.According to the DSA results,we compared CT and MRI application value in aortic dissection.Result：Diagnostic accuracy of CT and MRI were 100%in diagnosis,classification,true and false lumen,inner diaphragm in aortic dissection.CT/DSA group showed that 15/19 crevasse,crevasse 6/11 place again,vascular branches affected 44/45,22/0false lumen mural thrombus,ulcer 24/25,12/0aortic calcification.MRI/DSA group showed the 6/15 crevasse,crevasse 5/10 place again,vascular branches affected 24/39,20/0false lumen mural thrombus,ulcer 10/21,0/0aortic calcification.CTA showed aortic intramural hematoma in 2cases,but DSA not shown.MRI/DSA group did not show aortic intramural hematoma.Conclusion：CT and MRI in diagnosis of aortic dissection and classification present high sensitivity,specificity and accuracy,but in breach display and branching vascular involvement exist certain differences.They can complement each other for contraindication.