多层螺旋CT血管成像在破裂性腹主动脉瘤诊断及术前评估中的应用价值

Application values of multi-slice spiral CT angiography in diagnosis and preoperative evaluation of ruptured abdominal aortic aneurysm

目的探讨多层螺旋CT血管成像(MSCTA)在破裂性腹主动脉瘤(RAAA)诊断及术前评估中的应用价值。方法回顾性分析43例行MSCTA检查并经手术证实为RAAA的患者的影像学资料。观察患者的薄层轴位图像,然后根据病变情况利用MSCTA的多种图像重建技术进行图像重建,以明确RAAA分型,并分析RAAA的破口、周围血肿、腹腔积血、活动性造影剂外渗,瘤体的位置、形态、大小、累及范围、与周围组织的解剖关系,以及瘤壁钙化、血栓形成等影像表现。结果在43例RAAA患者中,MSCTA误诊为肿瘤2例、误诊为感染1例,MSCTA正确诊断40例,诊断准确率为93.02%。MSCTA显示的瘤体位置、分型、形态、腹腔积血、活动性造影剂外渗、血栓形成、瘤壁钙化、破口等影像学表现与手术结果相比,差异均无统计学意义(均P>0.05)。结论MSCTA具有无创、快速、覆盖范围广、分辨率高等特点,可为RAAA的诊断、术前评估、临床治疗方案的确定提供更为翔实的影像学信息。

Objective To explore the application values of multi-slice spiral CT angiography(MSCTA)in the diagnosis and preoperative evaluation of ruptured abdominal aortic aneurysm(RAAA).Methods The imaging data of 43 patients undergoing MSCTA examination and surgically confirmed with RAAA were retrospectively analyzed.The patients′thin-layer axial images were observed.Subsequently,the images were reconstructed by multiple image reconstruction techniques of MSCTA according to the conditions of the disease to clarify RAAA classification;in addition,the imaging manifestations of RAAA were analyzed,including rupture,peripheral hematoma,hemoperitoneum,extravasation of active contrast agent,and tumor location,shape,size,extent of involvement,and anatomical relationship with surrounding tissues,as well as mural calcification and thrombosis.Results Two cases were misdiagnosed as tumor,one case was misdiagnosed as infection,and 40 cases were correctly diagnosed by MSCTA in 43 RAAA patients,with a diagnostic accuracy of 93.02%.There were no statistically significant differences between the images manifestations indicated by MSCTA and the findings of the surgery with respect to tumor location,classification,shape,hemoperitoneum,extravasation of active contrast agent,thrombosis,mural calcification,and rupture(all P>0.05).Conclusion MSCTA has the characteristics of noninvasion,rapid surgery,wide coverage and high resolution,which can provide more detailed imaging information for the diagnosis,preoperative evaluation and determination of clinical treatment plan of RAAA.