超声、血管CTA联合诊断在StanfordA型主动脉夹层分型中应用价值

Application Value of Ultrasound and Vascular CTA Combined Diagnosis in Typing of Stanford A Type Aortic Dissection

目的探讨超声、血管多层螺旋CT(CTA)联合诊断在Stanford A型主动脉夹层分型中的应用价值。方法对78例高度怀疑Stanford A型主动脉夹层患者分别行超声和CTA检查,了解其分型,并以手术结果作为"金标准"。结果超声、CTA联合诊断Stanford A型主动脉夹层的准确率、敏感性分别为93.59%、100.0%明显高于超声(69.23%、72.58%)、CTA(74.36%、88.71%)(P<0.05);特异性无差异(P>0.05);三组联合诊断A1型、A2型、A3型的准确率无差异(P>0.05);CTA显示内膜片、内膜片累及范围、假腔血栓、主动脉弓受累、动脉弓分支受累的几率高于超声,显示心功能降低、主动脉反流的几率明显低于超声(P<0.05)。结论超声和CTA联合诊断Stanford A型主动脉夹层准确率及分型准确率较高,还可了解内膜片及其累及范围、假腔血栓等情况。

Objective To investigate the application value of ultrasound and vascular multi-slice spiral CT （CTA） combined diagnosis in typing of Stanford A aortic dissection. Methods 78 cases of patients with highly suspected Stanford A type aortic dissection were examined by ultrasound and CTA to know their types. The operation results were taken as the golden standard. Results The accuracy and sensitivity of ulnasound and CTA in the diagnosis of Stanford A type aortic dissection （93.59%, 100%） were significantly higher than that of ultrasound （69.23%, 72.58%） and CTA （74.36%, 88.71%） （P〈0.05）. There was no difference of specificity （P〉0.05）. There were no differences between the three groups in the combined diagnosis of A1 type, A2 type and A3 type （P〉0.05）. The probabilities of CTA showing intimal flap, scope involved by intimal flap, false lumen thrombus, aortic arch involvement and aortic arch branches involvement were higher than those of ultrasound while the probabilities in showing decreased heart function and aortic regurggitation were significantly lower than those of ultrasound （P〈0.05）.Conclusion The accuracy and typing accuracy of ultrasound and CTA in combined diagnosis of Stanford A type aortic dissection are relatively higher, which also can help to know the intimal flap and involved scope and false lumen thrombus, etc..