螺旋CT血管造影及仿真血管内窥镜在诊断主动脉病变中的应用

The Application of Spiral CT Angiography and Virtual Intravascular Endoscopy in the Diagnosis of Aortopathies

目的探讨螺旋CT血管造影 (SCTA)及仿真血管内窥镜 (VIE)成像方法及其在诊断主动脉病变中的应用价值。方法对 37例临床怀疑主动脉病变的患者进行螺旋CT增强扫描。容积扫描所得原始数据在同机工作站重建横断面图像 ,并分别进行多平面重建 (MPR)、表面遮盖显示 (SSD)、最大密度投影 (MIP)及VIE成像。结果主动脉夹层 17例 ,真性主动瘤 12例 ,假性动脉瘤 1例 ,主动脉炎 2例 ,正常主动脉 5例 ,其中 11例经手术证实 ,9例经血管数字减影检查证实 ,12例与MRI和 (或 )彩色B超诊断相符 ,5例正常主动脉未作其他检查。观察主动脉夹层以MPR及VIE为佳 ,能显示内膜片、真假腔及血栓情况 ,可显示破口位置与是否累及重要分支。SSD显示真性主动脉瘤最优 ,能立体、形象的显示动脉瘤大小、形态、部位及与主要分支的关系。VIE能直观的显示假性动脉瘤破口大小及位置 ,对主动脉炎能清晰显示不规则的血管内壁和狭窄。MIP适合于显示主动脉钙化情况及支架位置。结论螺旋CT血管造影和仿真血管内窥镜成像技术综合运用 ,可多方位显示主动脉解剖形态和病变 ,可直观、立体地对血管病变进行全面观察、分析 ,对疾病诊断、制定治疗方案或手术计划。

ObjectivesTo evaluate the clinical application of spiral CT angiography (SCTA) and virtual intravasular endoscopic imaging (VIEI) in the diagnosis of aortopathies.MethodsContrast enhanced spiral CT scanning of the aorta in 37 cases suspected clinically as aortopathies was performed . The original data obtained from volumetric scanning were utilized to reconstruct the transverse images at working station of the same machine . Multi planar reconstruction (MPR), surface shade display (SSD), maximum intensity projection (MIP) and VIEI were carried out separately in postprocessing of all cases.ResultsAll 37 cases included aortic dissection (17 cases), aneurysm (12 cases), pseudoaneurysm (1 case), arteritis (2 cases) and normal aorta (5 cases). Eleven cases out of these were confirmed by surgical operation ,9 cases were checked by DSA inspection, the diagnoses of 12 cases agreed with MRI and /or colored ultrasonography, no additional examination was scheduled for 5 cases with normal aorta. Aortic dissection could be better displayed by MPR and VIEI, showing the intimal flap , true and false lumen , intraluminal thrombi , the site of aneurysm rupture as well as whether important arterial branches were involved.SSD was the best choice for displaying the stereographic features of true aortic aneurysm, such as its size, three dimensional shape, location and its relation with main arterial branches. VIEI manifested clearly the site and size of pseudoaneurysm rupture, the anomalous inside wall and stenosis of aorta suffered from arteritis . MIP was useful to depict the calcification of aorta and the position of stent.ConclusionComprehensive application of SCTA and VIEI can better demonstrate the anatomical shape and lesion of aortopathies from multiple sites, can take a whole view towards the pathological changes of blood vessels. These are valuable tools for making a correct diagnosis of aortopathies, predicting the risk of operation and observing the postoperative efficacy. It will provide important and useful information when project of treatment and surgical approach. are worked out. [