MRI对主动脉夹层快速诊断的应用价值

The value of MRI in the rapid diagnosis of aortic dissection

目的 评价磁共振True-FISP、HASTE序列在主动脉夹层(AD)诊断中的应用价值。方法 选取同期运用True-FISP、HASTE和CTA进行胸部主动脉检查的患者,以CTA检查结果为金标准,将True-FISP、HASTE序列检查结果与其比较。从夹层累及范围(Stanford A、B分型)、破口位置的显示情况、主要分支动脉(头臂干动脉、左颈总动脉、左锁骨下动脉)受累情况三个方面进行统计分析。结果 主动脉夹层65例,True-FISP及HASTE序列诊断夹层累及范围及分型与CTA检查结果一致,A型夹层19例(其中壁间血肿3例)、B型夹层46例(其中壁间血肿11例)。CTA检出47个破口,受累分支31支。True-FISP序列检出破口44个,其中6个与CTA结果不符合;检出受累分支30支,其中4支与CTA结果不符合。HASTE序列检出破口33个,其中3个与CTA结果不符合;检出受累分支13支,其中2支与CTA结果不符合。True-FISP诊断破口敏感度80.85%、特异度70.10%,诊断受累分支敏感度83.87%、特异度95.94%。HASTE诊断破口敏感度63.83%、特异度82.35%;诊断受累分支敏感度35.48%、特异度98.36%。结论 磁共振True-FISP及HASTE序列可以在快速完成检查前提下对主动脉夹层进行准确诊断及分型;True-FISP序列对破口显示及主要血管分支受累诊断价值较高,而HASTE序列的诊断价值略低,对疑似AD患者True-FISP序列具有较高的应用价值。

Objective To evaluate the application value of MR True-FISP and HASTE sequences in the diagnosis of aortic dissection.Methods Cases of thoracic aortic examination using True-FISP,HASTE and CTA were retrospectively analyzed during the same period,and the results of CTA examination were used as the gold standard,and the results of True-FISP and HASTE sequences were compared with them.Statistical analysis was made from three aspects:the scope of dissection(Stanford A and B classification),the display of the location of the ruptures,and the involvement of the main branch arteries(brachioce-phalic trunk artery,left common carotid artery and left subclavian artery).Results A total of 65 cases of aortic dissection were collected.The extent and classification of dissection diagnosed by True-FISP and HASTE sequence were consistent with the re-sults of CTA examination,with 19 cases of type A dissection(including 3 cases of intermural hematoma),and 47 cases of type B dissection(including 11 cases of intermural hematoma).CTA detected 47 ruptures and 31 affected branches.44 ruptures were detected in the True-FISP sequence,6 of which were inconsistent with CTA results,and 30 affected branches were detected,4 of which were not consistent with the results of CTA.33 ruptures were detected in the HAST sequence,3 of which were inconsis-tent with CTA results,and 13 affected branches were detected,two of which were inconsistent with CTA results.True-FISP had a sensitivity of 80.85%and a specificity of 70.10%for the diagnosis of the ruptures,and the sensitivity and specificity of the af-fected branches were 83.87%and 95.94%.HASTE had a sensitivity of 63.83%and a specificity of 82.35%for the diagnosis of the ruptures,and the sensitivity and specificity of the affected branches were 35.48%and 98.36%.Conclusion True-FISP and HASTE sequences can accurately diagnose and classify aortic dissection on the premise of rapid completion of the examination.True-FISP sequences have a higher diagnostic value for rupture demonstration and involvement of major vascular branches,while the diagnostic value of HASTE sequences is slightly lower.The True-FISP sequence has high application value in patients with suspected aortic dissection.