CT在鉴别急性与慢性主动脉夹层中的诊断价值

Diagnostic value of CT in differentiating acute and chronic aortic dissection

目的评估并比较急性与慢性主动脉夹层(aortic dissection,AD)的计算机断层扫描(CT)影像学特征,并确定某些影像学特征在预测AD患者急性和慢性病程中的诊断价值。方法随机选取AD患者53例,其中急性AD患者37例,慢性AD患者16例,全部患者均静脉注入造影剂,应用CT扫描仪的增强成像技术对患者胸腹部血管进行联合扫描,存储图像并用于后续分析。结果①急性AD患者均表现为主动脉周围脂肪浸润,慢性AD均表现为假腔外血管壁钙化(P<0.05);②急性AD多表现为曲线型剥脱内膜,慢性AD多表现为剥脱内膜假腔侧钙化、直线型剥脱内膜,差异具有统计学意义(P<0.05);③急性AD剥脱内膜厚度小于慢性AD,急性AD假腔内径小于慢性AD,急性AD剥脱内膜活动度大于慢性AD,差异均具有统计学意义(P<0.001);④AD剥脱内膜厚度、假腔内径及剥脱内膜活动度对诊断慢性剥脱内膜活动度均具有较高的诊断价值(P<0.01),受试者工作特征曲线的曲线下面积分别为0.878、0.726、0.870。结论 AD的多种影像学特征可用于对疾病的急性或慢性进行鉴别,为临床治疗方案选择提供依据。

Objective To evaluate and compare the computed tomography ( CT) imaging features of acute and chronic aortic dissection ( AD), and determine the diagnostic value of some imaging features in predicting the acute and chronic course of AD. Methods Fifty-three patients with AD were randomly selected, including 37 patients with acute AD and 16 patients with chronic AD. Contrast agents were injected intravenously into all patients. The thoracic and abdominal vessels of the patients were scanned by enhanced CT scanner, and the images were stored for subsequent analysis. Results All the patients with acute AD showed periaortic fat infiltration, while those with chronic AD showed out wall calcification of false lumen ( P < 0. 05 ). The most common manifestations of acute AD were curved shape of flap, while those of chronic AD showed straight shape (P < 0. 05 ). The difference was statistically significant ( P < 0. 05 ). The flap thickness of acute AD was less than that of chronic AD, the false lumen diameter of acute AD was less than that of chronic AD, and the flap motion of acute AD was greater than that of chronic AD. The difference was statistically significant ( P < 0. 001 ). The flap thickness, the false lumen diameter and the flap motion had high diagnostic value for predicting chronic AD (P <0. 01 ). The area under the curve was 0. 878 , 0. 726 and 0. 870, respectively. Conclusion Various imaging features of AD can be used to differentiate acute from chronic diseases, which will provide a basis for the choice of clinical treatment.