GE 3.0血管成像与CTA在TAVR术前诊断效果的对比分析

Comparative analysis of preoperative diagnosis of GE 3.0 angiography and CTA in TAVR

目的 探讨GE3.0血管成像与CTA在经导管主动脉瓣置换术(TAVR)术前对主动脉瓣面积和钙化评估准确性。方法 回顾性分析在我院2015年1月~2017年12月接受TAVR治疗的AS患者80例,根据术前分别应用GE3.0血管成像与CTA检查。使用CTA及GE3.0配套电脑软件处理图像,二者配套软件可进行多重平面重建、曲线平面重建、最大密度投影及容积再现。主动脉瓣采用4分量表评估半定量评估法,程度包括其高度钙化、中度钙化、重度钙化、大量钙化。结果 GE3.0血管成像TAVR术前对主动脉瓣面积大于CTA(P<0.05),但舒张期、收缩期Bland-Altman值比较无统计学意义(P>0.05)。GE3.0血管成像在TAVR术前检查舒张期右冠状动脉窦距离小于CTA(P<0.05),距离左冠状动脉窦距离小于CTA,但差异比较无统计学意义(P>0.05)。GE3.0血管成像在TAVR术前测量患者窦管交界平面指标中的长径、周长、面积大于CTA(P<0.05),距离瓣环高度、短径、平均径、周长平均径、面积平均径大于CTA,差异比较无统计学意义(P>0.05)。GE3.0血管成像与CTA在TAVR术前检查舒张期主动脉瓣面积及距离左右冠状动脉窦距离的一致性高(ICC=0.960,0.790,0.896)。GE3.0血管成像与CTA在TAVR术前检测动脉瓣钙化程度比较差异无统计学意义(Z=-0.027,P=0.978)。结论 GE3.0血管成像与CTA在TAVR术前对主动脉瓣平均面积和钙化评估准确性一致,可作为主动脉瓣狭窄术前诊断方法。

Objective To compare the accuracy of GE3.0 angiograohy versus computed tomography angiography (CTA) in the evaluation of aortic valve area and calcification before transcatheter aortic valve replacement (TAVR). Methods 80 AS patients underwent TAVR in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients received the GE3.0 angiography or CTA before operation, then various technologies were used to process the images, including multiplanar reconstruction (MPR), curved planar reformation (CPR), maximal intensity projection (MIP), and volume rendering (VR). Aortic valves were assessed semi-quantitatively by a four-component scale, including high calcification, moderate calcification, severe calcification and massive calcification. Results The aortic valve area showed by the GE3.0 angiograohy was larger than that of the CTA before TAVR, with statistic difference ( P <0.05);While, no difference was found in the Bland-Altman values in the diastolic and systolic phases ( P >0.05). The distance to the right coronary sinus ( P <0.05) and left coronary sinus ( P >0.05) in the diastolic phase showed by the GE3.0 angiograohy was lower than that of the CTA before TAVR. The sinotubular junction indexes measured by the GE3.0 angiograohy was larger than that of the CTA before TAVR, while no difference was found in the long diameter, circumference and area ( P >0.05), with statistic difference in the distance from the annulus height, short diameter, mean diameter, circumference average diameter, area average diameter ( P <0.05). The consistency of GE3.0 angiography and CTA measuring diastolic aortic valve area and distance from left and right sinus antrum before TAVR was relatively high (ICC=0.960, 0.790, 0.896). GE3.0 angiography or CTA had no difference in measuring the calcification degree before TAVR ( P >0.05). Conclusion The accuracy of both GE3.0 angiography and CTA in evaluating the aortic valve area and calcification before TAVR is similar, which can be used as preoperative diagnosis of aortic stenosis.