DSCTA检查在腹主动脉瘤诊断及EVE术后随访中的临床价值

Clinical Value of Dual-source CT Angiography in Diagnosis and Following-up Postoperative Endovascular Stentgraft Exclusion of Abdominal Aortic Aneurysm

目的探讨DSCTA(dual-source CT angiography,DSCTA)检查在腹主动脉瘤(abdominal aortic aneurysm,AAA)诊断及腔内支架隔绝(endovascular stent-graft exclusion,EVE)术后随访中的临床价值。方法 86例患者经DSCTA检查诊断为AAA,其中16例肾下型患者EVE术后行DSCTA随访。在工作站上完成患者的图像后处理及分析工作,重建技术包括多平面重组(MPR)、最大密度投影(MIP)及容积再现技术(VRT)等。AAA患者重点观察AAA的类型、部位、大小、累及范围,并按照腔内隔绝术的要求对肾下型AAA进行相关参数测量并分型;行EVE治疗患者重点观察AAA的转归及并发症情况。结果 186例患者包括4例肾上型、82例肾下型。2依据腔内隔绝术的要求,82例肾下型患者分为Ⅰ型9例、ⅡA型6例、ⅡB型12例、ⅡC型42例、Ⅲ型13例。3DSCTA图像能准确显示每位患者瘤体的形态、部位、大小,与主动脉重要分支血管的关系及附壁血栓,能准确测量AAA的相关数据。416例EVE治疗患者术后AAA均不同程度缩小或保持稳定,支架覆盖区支架外瘤体均基本血栓化、内膜下未见血栓形成。12例腹主动脉内支架形态正常、4例支架稍变形。所有患者均未见支架内漏发生。结论 DSCTA检查具有操作简便、准确性高且无创等优点,可以作为AAA诊断与监测、术前评价及EVE术后随访的重要影像学工具。

Objective To investigate the value of dual-source CT angiography( DSCTA) in diagnosis and following-up postoperative endovascular stent-graft exclusion( EVE) of abdominal aortic aneurysm( AAA). Methods Eighty-six patients were diagnosed as AAA by dual-source CT angiography. Of these patients,16 patients with aneurysm body under renal artery underwent EVE were following-up observed by DSCTA. Imaging reconstruction that include multi-plane reconstruction( MPR),maximum intensity projection( MIP) and volume rendering technique( VRT),and analysis were finished at workstation. Type,location,size and extension of AAA were focused. Besides,based on correlative measured parameters that satisfied requirement of EVE,AAA located under level of renal artery was classified. The outcomes and complications of 16 patients with AAA underwent EVE were focused. Results 1Eighty-six cases included 4 with aneurysm body located upper level of renal artery and 82 with aneurysm body located under level of renal artery. 2Based on requirement of EVE,82 cases with aneurysms body located under level of renal artery were classified as 9 typeⅠ,6 type ⅡA,12 type ⅡB,42 type ⅡC and 13 type Ⅲ。3DSCTA images clearly displayed shape,locality and size of aneurysm,and anatomic relation between aneurysm body and adjacent main branches of aorta,and mural thrombus in all patients. Furthermore,relative data of AAA could also be accurately measured on CTA images. 4 The size of aneurysm body reduced to varying degrees or stabilized in all 16 cases underwent EVE,outer area of aneurysm body covered by stent-graft were almost filled with thrombus,and inner surface of stent-graft didn’t observed thrombus in every patient. Shape of stent-graft was normal in 12 cases and slightly abnormal in 4 cases. Stent endoleaking weren’t observed in 16 cases. Conclusion DSCTA examination with handy,effective and non-invasived advantages,is one of important imaging methods in diagnosis and mo-nitoring,preoperative evaluation,and following-up postoperative EVE of AAA.