主动脉瓣关闭不全解剖结构CT精准评估与术中实际测量的对比研究

Comparative study of CT accurate evaluation and intraoperative measurement of aortic valve insufficiency

目的对主动脉瓣关闭不全患者进行主动脉瓣CT精准评估,为手术方式选择与手术方案制定提供参考依据。方法对主动脉瓣关闭不全患者常规行术前全心动周期CT检查,用Mimics软件对影像数据进行评估,2021年1月到2022年1月期间对125例用CT精准评估的方法对拟手术的主动脉瓣进行测量评估;对69例患者术中实际测量主动脉瓣瓣叶几何高度(gH)和游离缘长度(FML),用Bland-Altman图一致性分析CT精准评估与术中实际测量的一致性。结果两种方法测量主动脉瓣瓣叶gH,差值均数为0.1 mm,95%可信区间(CI):-1.9~2.1 mm,有2个点在CI以外;测量瓣叶FML,差值均数为0.4 mm,95%CI:-1.8~2.6 mm,有1个点在CI以外,差异在临床上可以接受。结论CT精准评估与术中实际测量瓣叶gH和FML的一致性好,是主动脉瓣术前测量评估解剖结构的准确方法,可作为主动脉瓣关闭不全修复术前患者选择和手术修复的重要参考依据。

Objective Accurate evaluation of aortic valve CT in patients with aortic valve insufficiency provided a reference for the selection of surgical methods and the formulation of surgical plans.Methods Preoperative total cardiac cycle CT examinations were routinely performed in patients with aortic valve insufficiency.Image data were evaluated using Mimics software.Aortic valve measure⁃ments were evaluated in 125 patients between January 2021 and January 2022 using CT accurate evaluation.The geometric height(gH)and free margin length(FML)of aortic valve were measured in 69 patients during operation,and the consistency between CT accurate estimation and actual measurement was analyzed by bland-Altman diagram.Results The mean difference of gH measured by the two methods was 0.1 mm,and the 95%consistency limit was(-1.9 mm,2.1 mm),with 2 points outside the consistency limit.FML was measured and the mean difference was 0.4 mm with the 95%consistency limit of(-1.8 mm,2.6 mm).There was 1 point outside the consistency limit,and the difference was clinically acceptable.Conclusion CT accurate evaluation is consistent with actual intraoper⁃ative measurement for valve gH and FML.CT is an accurate method for preoperative measurement and evaluation of aortic valve anatom⁃ical structure,and can be used as an important reference for patient selection and surgical repair before aortic valve insufficiency repair.