多层螺旋CT血管成像及后处理技术在主动脉夹层患者中的应用效果

Application value of multi-slice spiral CT angiography and post-processing techniques in patients with aortic dissection

目的探讨多层螺旋CT血管成像(MSCTA)及后处理技术在主动脉夹层(AD)患者中的应用价值。方法回顾性分析2012年10月至2017年3月淮南市第一人民医院收治的22例应用MSCTA及三维重建后处理技术诊断的AD患者的临床资料,分析AD患者MSCTA检查的影像学特点,比较数字减影血管造影(DSA)与MSCTA在主动脉管壁内膜破口总数量和测量左侧锁骨下动脉水平主动脉管径方面的差异。结果 22例患者按De Bakey法分型:Ⅰ型2例(9.09%),Ⅱ型5例(22.73%),Ⅲ型15例(68.18%)。主动脉内膜初始撕裂的初破口位于升主动脉7例(31.81%),主动脉峡部13例(59.09%),胸主动脉1例(4.55%),腹主动脉1例(4.55%)。所有患者均发现夹层远端内膜1个或多个再破口;再破口数量≥2个10例(45.45%),单个12例(54.55%)。其中14例患者完善DSA检查,与DSA检查结果比较,MSCTA在显示内膜破口数量和测量左侧锁骨下动脉水平主动脉管径方面,差异无统计学意义(P=0.375;P=0.311)。结论 MSCTA及三维重建后处理技术对诊断AD具有较高的应用价值。

Objective To investigate the application values of multi-slice spiral CT angiography（ MSCTA） and post-processing techniques in those patients with aortic dissection（ AD）. Methods The clinical data of 22 patients with AD,diagnosed by means of MSCTA and 3 D reconstruction post-processing techniques in our hospital between Oct 2012 and Mar 2017,were retrospectively analyzed. Their MSCTA imaging characteristics concerning AD diagnosis were described,and differences between MSCTA and digital subtraction angiography（ DSA） in the measurement of number of intimal entry tears in aortic wall and aortic diameter at left subclavian artery level were compared.Results Of the 22 cases with AD,2 cases（ 9. 09%） were with De Bakey type I dissection,5 cases（ 22. 73%） with type II dissection and15 cases（ 68. 18%） with type III dissection. There were 7 cases（ 31. 81%） having initial aortic intimal entry tears in the ascending aorta,13 cases（ 59. 09%） in the aortic isthmus,1 case（ 4. 55%） in the thoracic aorta and 1 case（ 4. 55%） in the abdominal aorta. All patients were found to have one or more intimal re-entry tears in the distal dissection,of which 10 patients（ 45. 45%） had more than one re-entry tears and 12 patients（ 54. 55%） with only one. Fourteen patients underwent both DSA and MSCTA,and among them no significant difference was found between the MSCTA and DSA results when measuring number of aortic intimal entry tears and aortic diameter at left subclavian artery level（ P = 0. 375; P = 0. 311）. Conclusion Combination of MSCTA and 3 D reconstruction post-processing techniques would have higher application value in the diagnosis of aortic dissection.