MSCTA对Stanford B型主动脉夹层的诊断价值及其与DSA对比研究

Diagnostic Value of MSCTA for Stanford Type B Aortic Dissection and the Comparison with DSA

目的对比研究多层螺旋CT血管成像(MSCTA)与数字减影血管造影(DSA)对Stanford B型主动脉夹层(AD)的诊断价值。方法 2015年2月-2018年6月期间我院收治的55例AD患者行MSCTA检查,完成二维、三维CT图像重建,着重观察升主动脉、主动脉弓、降主动脉、腹主动脉、双侧髂内外动脉、肠系膜上动脉、双侧肾动脉及其属支情况,分析是否存在主动脉夹层、破裂口位置,作出AD分型诊断,并与DSA检查结果进行比较。结果 MSCTA检查共发现AD破口48例(87.27%),与DSA检查发现的AD破口52例(94.55%)比较,差异无统计学意义(P>0.05),且两种检查显示破口平面主动脉直径差异无统计学意义(P>0.05)。DSA、MSCTA检查对双腔征、线样征、内膜瓣、壁内血肿、瘤样扩张、伴血栓及钙化等影像学表现检出率比较均无统计学意义(P>0.05)。以DSA检查结果为金标准,MSCTA对AD累及升主动脉、髂总动脉、肾动脉、肠系膜上动脉的诊断准确率均>80%,且MSCTA诊断Stanford B型AD的敏感度、特异度及准确性分别为94.44%、84.21%、90.91%。结论 MSCTA对Stanford B型AD的诊断效能高,可作为首选的无创检查手段进行推广。

Objective To study the diagnostic value of multi-slice spiral CT angiography(MSCTA)and digital subtraction angiography(DSA)for Stanford type B aortic dissection(AD).Methods A total of 55 patients with AD who were admitted to the hospital during February 2015 to June 2018 were examined with MSCTA.Two-dimensional and threedimensional CT images were reconstructed.The ascending aorta,aortic arch,descending aorta,abdominal aorta,bilateral common iliac arteries,internal and external iliac arteries,superior mesenteric artery,bilateral renal arteries and their branches were observed.The presence of AD and rupture site was analyzed.The typing of AD was performed and compared with the results of DSA.Results There was no statistically significant difference in the number of cases with AD rupture found by MSCTA and DSA[48 cases(87.27%)vs 52 cases(94.55%)](P>0.05),and the was no statistically significant difference between the two examinations in the diameter of the aorta on the rupture plane(P>0.05).There were no statistically significant differences in the detection rates of imaging findings such as dual-chamber signs,line-like signs,intimal flaps,intramural hematoma,tumor-like dilatation,thrombosis and calcification by DSA and MSCT(P>0.05).With results of DSA as the golden standard,the diagnostic accuracy rates of MSCTA for AD involving the ascending aorta,common iliac artery,renal artery and superior mesenteric artery were higher than 80%.The sensitivity,specificity and accuracy of MSCTA in diagnosis of Stanford B type AD were 94.44%,84.21%,and 90.91%,respectively.Conclusion MSCTA is with high diagnostic efficiency for Stanford type B AD and it can be used as a preferred non-invasive method.