Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes

Acute aortic syndrome(AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection(AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT(MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., "beak sign", aortic "cobwebs" that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the rightdiagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.

Significance of an additional unenhanced scan in computed tomography angiography of patients with suspected acute aortic syndrome

AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.

Acute coronary syndrome on non-electrocardiogram-gated contrastenhanced computed tomography

It is not rare for acute coronary syndrome(ACS)patients to present with symptoms that are atypical,rather than chest pain.It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms,normal initial biomarkers of myocardial necrosis,and normal or nondiagnostic electrocardiograms(ECGs).Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS,it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients.However,several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT.A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient’s presenting symptoms.In order to avoid inappropriate management for this life-threatening event,clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.

Triple rule-out computed tomography angiography:Evaluation of acute chest pain in COVID-19 patients in the emergency department

BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females ) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unil ateral shadow in 16 (19.52%). The lung CT findings were sub pleural focal con solidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large a rea consolidation in 9 (10.97%), ground glass blurry shadow in 31 (37.80%), a lveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51% ). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesi ons tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub pleural focal consolidation, flaky cloudy shadow, large area consolidation, grou nd glass blurry shadow, and often accompanied with signs of broncho inflat ion. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid pr ogressions or changes on the size, amount, and distribution of the lesions likel y to be found in dynamic observation of chest X ray and CT scanning, i.e., ma rkedly dynamic changes found within 24 to 48 hrs. Lesions with these characteris tics may be recognized as pulmonary changes possibly induced by SARS. Complicati ons were found in 6 patients (7.31%), including tuberculosis of lung and brain a ccompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SAR S, by which more accurate assessment of the abnormal changes of lung and occurre nce of complications in SARS patients can be made.

Prevalence of Bicuspid Aortic Valve in Turner Syndrome Patients Receiving Cardiac MRI and CT: A Meta-Analysis

Turner syndrome(TS)is a rare disorder affecting 25–50 in 100000 female newborns.Bicuspid aortic valve(BAV)is assumed to be the most common congenital heart defect(CHD)in TS.In literature,reported BAV prevalence in TS ranges between 14%and 34%.The specific BAV prevalence in TS is still unknown.The aim of this study was to give a more precise estimation of BAV prevalence in TS by conducting a meta-analysis of TS-studies,which detected BAV by either cardiac magnetic resonance imaging(MRI)or cardiac computed tomography(CT).We searched PubMed,Cochrane Library,and Web of Science databases to collect observational studies including the prevalence of BAV identified by cardiac MRI or cardiac CT in TS patients up to June 4th,2021.After screening for inclusion,data extraction,and quality assessment by two independent reviewers,the meta-analysis was performed with R 4.1.1 software.Results are shown as proportion and weighted mean difference with 95%confidence intervals(95%CI).In total,11 studies involving 1177 patients were included.Pooled data showed that the prevalence of BAV in TS patients was 23.7%(95%CI:21.3%to 26.1%).No high heterogeneity was found between the included studies.The current meta-analysis reveals that BAVcan be detected in 23.7%of TS patients receiving cardiac MRI or cardiac CT.Therefore,BAV can be considered as the most common CHD in TS.Compared to TTE,cardiac MRI and cardiac CT might represent superior imaging modalities in BAV assessment of adult TS patients.

Contrast-induced acute kidney injury:A review of practical points

Contrast-induced acute kidney injury(CI-AKI) is oneof the most common causes of AKI in clinical practice.CI-AKI has been found to be strongly associated with morbidity and mortality of the patients.Furthermore,CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease.Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies.CI-AKI is an active research area thus clinicians should be updated periodically about this topic.In this review,we aimed to discuss the indications of contrastenhanced imaging,types of contrast media and their impact on nephrotoxicity,major pathophysiological mechanisms,risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.

Pathophysiology, clinical features and radiological findings of differentiation syndrome/all-trans-retinoic acid syndrome

In acute promyelocytic leukemia, differentiation thera-py based on all-trans-retinoic acid can be complicated by the development of a differentiation syndrome(DS). DS is a life-threatening complication, characterized by respiratory distress, unexplained fever, weight gain, interstitial lung infiltrates, pleural or pericardial effusions, hypotension and acute renal failure. The diagnosis of DS is made on clinical grounds and has proven to be difficult, because none of the symptoms is pathognomonic for the syndrome without any definitive diagnostic criteria. As DS can have subtle signs and symptoms at presentation but progress rapidly, end-stage DS clinical picture resembles the acute respiratory distress syndrome with extremely poor prognosis; so it is of absolute importance to be conscious of these complications and initiate therapy as soon as it was suspected. The radiologic appearance resembles the typical features of cardiogenic pulmonary edema. Diagnosis of DS remains a great skill for radiologists and haematologist but it is of an utmost importance the cooperation in suspect DS, detect the early signs of DS, examine the patients' behaviour and rapidly detect the complications.

A (H1N1) Influenza Pneumonia with Acute Disseminated Encephalomyelitis:A Case Report

INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.

The Clinical Characteristics and Imaging Findings of Morning Glory Syndrome

To investigate the features of CT, ultrasonography and fundus fluorescein angiography （FFA） of morning glory syndrome, the data on CT, A/B-scan ultrasonography and fundus fluorescein angiography （FFA） were retrospectively analyzed in 8 cases of morning glory syndrome （MGS）. Among those cases, 6 were examined with CT, 4 with FFA and 8 with A/B-scan ultrasonography. Results showed that the characteristics of CT, A/B-scan ultrasonography and FFA in MGS included： （1） The attachment spot of optic nerve became thin and vitreous body protruded to the posterior wall of eyeball with a spherical shape on CT image; （2） in the early period of FFA, hypofluorescence appeared on the optic, the abnormal arteriae and veins around the optic papilla were displayed clearly and in the late period, optic disc was stained with fluorescein; （3） on B-scan ultrasonogram, the vitreous cavity extended to the posterior pole and optic papilla, and projected to the basal part of muscle cones and thus the posterior part of vitreous cavity looked like an upside-down bottleneck. Sometimes the echogenic band of retinal detachment could also be seen. On A-scan ultrasonogram, both vitreous cavity and bottleneck showed no ultrasonic echoes and presented a base line without any evident wave crest. It is concluded that CT, A /B-scan ultrasonography and FFA could show the imageological features of MGS from different aspects, which helps clinicians to differentiate it from other diseases such as optic disc coloboma. CT and A /B-scan ultrasonography, in particular, are considered to be reliable imageological methods for the accurate diagnosis of MGS and are superior to the traditional techniques.

Causes of epigastric pain and vomiting after laparoscopic-assisted radical right hemicolectomy-superior mesenteric artery syndrome

BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition causing functional obstruction of the third portion of the duodenum.Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.AIM To analyze the clinical features,risk factors,and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopicassisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022.The occurrence of SMAS and its countermeasures were evaluated.Among the 256 patients,SMAS was confirmed in six patients(2.3%)by postoperative clinical presentation and imaging features.All six patients were examined by enhanced computed tomography(CT)before and after surgery.Patients who developed SMAS after surgery were used as the experimental group.A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group.The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group.The preoperative body mass index(BMI)of the experimental group and the control group was calculated.The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded.The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared.The differences in angle,distance,BMI,type of lymphadenectomy and surgical approach between the experimental and control groups were compared,and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.RESULTS In the experimental group,the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery(P<0.05).The aortomesenteric angle,distance and BMI were significantly higher in the control group than in the experimental(P<0.05).There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups(P>0.05).CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication.Over-cleaning of lymph fatty tissues may also be associated with this complication.

Early X-ray and CT appearances of severe acute respiratory syndrome: an analysis of 28 cases

Objective To study the early X-ray and CT findings of patients with severe acute respiratory syndrome (SARS).Methods Chest radiography and CT were performed in 28 patients with SARS within one to three days after onset of the disease. CT examinations included conventional spiral CT and high-resolution CT (HRCT). The radiographic and CT findings of these patients were analyzed retrospectively.Results Abnormal CT findings were noted in all the patients, but abnormal chest radiographic findings in 17 cases (60.7%, 17/28). CT showed single small focal patchy opacities in 23 patients (82.1%, 23/28), including oval ground-glass opacities in 20 patients, lobular distribution ground-glass opacities in 2 and small patchy consolidation in one. Multi-focal ground-glass opacities were found in 2 patients and extensive opacities in three. In the 28 patients, a total of 31 lesions were found in the upper (7, 22. 6%), middle (3,9.7%) ,and lower lobes (21, 67.7%). The diameter of the lesions ranged from 20 to 35 mm.Conclusion The dominant feature of early SARS patients is focal patchy opacity in the lung, and oval small ground-glass opacities are the common morphological findings on CT.

Clinical and imaging findings in patients with severe acute respiratory syndrome

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome (SARS), and to study their relationship Methods Forty six SARS confirmed patients were admitted to our hospital from February to April, 2003 X ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features Results Fever was found in 97 8% of the patients Clinical symptoms were mild, but X ray and CT findings were distinct CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases Different findings on radiography and CT were related to the different phases of the disease After treatment, most lesions were absorbed completely, but slowly in patients with multi lobe consolidation and/or extensive interstitial infiltration Conclusion Special clinical and imaging findings could be found in SARS cases The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT

Interrupted aortic arch diagnosed by ECG-gated multi-slice computed tomography angiography: a case report

Interrupted aortic arch （IAA） is a rare congenital cardiovascular disease with major intracardiac defects and always with multisystem non-cardiac malformations. It occurs in 1 ： 10,000 births, and about 1% of the patients with congenital heart defects. Therefore, it is important that we make a good diagnosis and accurate evaluation of their morphologic conditions before a heart operation. We presented a case of IAA diagnosed by ECGgated multi-slice computed tomography （MSCT） angiography.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection as A Risk Factor for Thromboembolic and Acute Ischemic Stroke:A Case Report

Increasing evidence reports a greater incidence of stroke in patients with coronavirus disease 2019(COVID-19)than in the non-COVID-19 population and suggests that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection represents a risk factor for thromboembolic and acute ischemic stroke.Elderly people have higher risk factors for acute ischemic stroke or embolic vascular events,and advanced age is strongly associated with severe COVID-19 and death.We reported,instead,a case of an ischemic stroke in a young woman during her hospitalization for COVID-19-related pneumonia.A 29-year-old woman presented to the emergency department of the First Affiliated Hospital,Zhejiang University School of Medicine with progressive respiratory distress associated with a 2-day history of fever,nausea,and vomiting.The patient was transferred to the intensive care unit(ICU),where she underwent tracheostomy for mechanical ventilation due to her severe clinical condition and very low arterial partial pressure of oxygen.The nasopharyngeal swab test confirmed SARS-CoV-2 infection.Laboratory tests revealed neutrophilic leukocytosis,prolonged prothrombin time,and elevated D-dimer and fibrinogen levels.Left hemiplegia was reported 18 days later during her stay in the ICU after discontinuation of the sedative medications.Central facial palsy on the left side,dysarthria,and facial droop were present,with complete paralysis of the ipsilateral upper and lower limbs.Computed tomography(CT)of the head and magnetic resonance imaging of the brain confirmed the presence of lesions in the right hemisphere affecting the territories of the anterior and middle cerebral arteries,consistent with ischemic stroke.Pulmonary and splenic infarcts were also found after CT of the chest.The age of the patient and the absence of serious concomitant cardiovascular diseases place the emphasis on the capacity of SARS-CoV-2 infection to be an independent cerebrovascular risk factor.Increased levels of D-dimer and positivity forβ2-glycoprotein antibody could confirm the theory of endothelial activation and hypercoagulability,but other mechanisms-still under discussion-should not be excluded.

多层螺旋计算机断层扫描多维重建参数、血管活性药物评分在急性主动脉夹层预后中的预测价值

目的探讨多层螺旋计算机断层扫描(CT)多维重建(MPR)参数、血管活性药物评分(VIS)在急性主动脉夹层预后中的预测价值。方法收集2017年4月至2022年4月于聊城市第二人民医院(山东第一医科大学附属聊城二院)进行手术治疗的68例急性主动脉夹层患者的临床资料,根据是否发生院内死亡将其分为死亡组(n=24)和对照组(n=44)。对比两组患者的主动脉夹层的MPR参数、血管活性药物评分(VIS),绘制受试者工作特征(ROC)曲线分析MPR参数与VIS预测急性主动脉夹层患者院内死亡的价值,采用Logistic回归模型分析MPR参数、VIS与患者术后发生院内死亡风险的关系。结果死亡组患者侵犯血管条数、假腔面积占主动脉管腔面积之比、VIS均高于对照组患者,差异均有统计学意义(P﹤0.05)。中性粒细胞与淋巴细胞计数比值(NLR)越高、输血量越大、呼吸机使用时间越长、合并败血症、合并肺部感染、并发意识障碍、假腔面积占主动脉管腔面积之比升高、VIS升高均是急性主动脉夹层患者术后发生院内死亡的独立危险因素(P﹤0.05)。ROC曲线分析显示,侵犯血管条数、假腔面积占主动脉管腔面积之比、VIS预测急性主动脉夹层患者术后死亡风险的曲线下面积(AUC)分别为0.611、0.861、0.949。结论假腔面积占主动脉管腔面积之比、VIS可在一定程度上预测急性主动脉夹层患者术后发生院内死亡的风险,值得在临床上进一步推广应用。

冠状动脉周围脂肪衰减指数联合实验室指标预测急性冠脉综合征的研究

目的探讨冠状动脉周围脂肪衰减指数(fat attenuation index,FAI)联合实验室指标预测冠心病(coronary heart disease,CHD)患者发生急性冠状动脉综合征(acute coronary syndrome,ACS)风险的价值。方法回顾性分析2015年至2020年南方医科大学附属广东省人民医院确诊的CHD患者454例病历资料,将其分为稳定性冠心病(stable coronary artery disease,SCAD)组(n=233)与ACS组(n=221)。采用Logistic回归分析冠状动脉主要分支[右冠状动脉(right coronary artery,RCA)、左前降支(left anterior descending branch,LAD)及左旋支(left circumflex branch,LCX)]的FAI值、实验室指标及临床资料,筛选CHD患者发生ACS的独立影响因素;构建受试者操作特征曲线,并计算曲线下面积(area under the curve,AUC),评价独立影响因素及其联合应用的预测效能。结果LAD-FAI、RCA-FAI及高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)是CHD患者发生ACS的独立影响因素。LAD-FAI、RCA-FAI、hs-CRP值升高单独预测CHD患者发生ACS的AUC分别为0.568、0.703、0.749,三者联合预测的AUC为0.815。结论LAD-FAI、RCA-FAI与hs-CRP联合对CHD患者发生ACS的风险具有较好的预测效能。

多层螺旋CT血管造影对急性主动脉综合征的诊断和影像学特征

目的:探讨多层螺旋CT血管造影(MSCTA)对急性主动脉综合征(AAS)的诊断及影像学特征。方法:选取2020年6月至2022年7月于阜阳市人民医院诊治的185例疑似AAS患者,在确诊前予以多层螺旋CT(MSCT)平扫、MSCTA检查,以数字血管减影(DSA)诊断结果为“金标准”,采用四格表法计算MSCT平扫,MSCTA的阳性、阴性预测值,采用受试者工作特征(ROC)曲线分析MSCT平扫、MSCTA诊断AAS的ROC曲线下面积(AUC)值、灵敏度及特异度。结果:在185例疑似AAS患者中,以DSA诊断结果为“金标准”确诊82例为急性主动脉综合征;经MSCT平扫检查后,其阳性预测值为68.35%,阴性预测值为73.58%;经MSCTA检测后,阳性预测值为96.30%,阴性预测值为96.15%。MSCTA的诊断确诊率(178/185)高于MSCT平扫(132/185),差异有统计学意义(χ^(2)=42.092,P<0.05)。MSCTA的破口位置(升主动脉、主动脉弓及降主动脉)的检出率高于MSCT平扫,差异有统计学意义(χ^(2)=6.788、4.000、12.974,P<0.05)。ROC曲线分析显示,MSCT平扫、MSCTA诊断AAS的AUC值分别为0.698和0.946。结论:MSCTA诊断AAS具有较高的效能,且AAS多见于主动脉夹层分离和主动脉壁间血肿。

MSCT一站式检查急性胸痛三联征患者的临床价值

目的 探讨多层螺旋CT(MSCT)一站式检查急性胸痛三联征患者的临床价值。方法 选取急性胸痛三联征患者96例,均予以MSCT一站式联合筛查(肺动脉CTA、主动脉CTA、冠状动脉CT扫描),以冠状动脉造影检查为金标准,同时分析MSCT检查后患者主动脉、肺动脉及冠状动脉组织结构重构,分析图像质量及诊断效能。结果 96例急性胸痛三联征病变患者中,冠状动脉狭窄病变49例(单支病变23例、双支病变14例,三支病变12例);主动脉夹层动脉瘤10例,肺栓塞10例,心包炎8例,气胸7例,肺部感染6例,胸腔积液6例。MSCT检查诊断率92.71%,灵敏度93.18%,特异度87.50%,与冠状动脉造影检查对比中差异无统计学意义(P>0.05)。96例患者中总计1245段冠状动脉图像,其中优、良、差占比分别为82.01%、12.93%、5.06%。结论 MSCT一站式检查急性胸痛三联征能及时准确提示病因,具有重要临床意义。

冠状动脉计算机断层扫描血管造影对老年急性冠状动脉综合征患者斑块特征的诊断效能及对预后的预测价值

目的探讨冠状动脉计算机断层扫描血管造影(CCTA)对老年急性冠状动脉综合征(ACS)患者斑块特征的诊断效能及对预后的预测价值。方法回顾性分析2021年2月至2022年12月海南省琼海市人民医院胸痛中心收治的疑似冠心病的208例老年患者的临床资料,其中58例发生ACS,纳入ACS组。根据ACS组患者性别、年龄及心血管危险因素(吸烟史、高血压、糖尿病、血脂水平等),采用倾向评分匹配法(比例1∶1)同期选择58例发生稳定型心绞痛(SAP)的患者纳入SAP组。所有患者均行CCTA检查,比较两组患者斑块长度、钙化斑块(CP)体积、非钙化斑块(NCP)体积、总斑块体积、CP负荷、NCP负荷和总斑块负荷等斑块特征参数。此外,根据预后将58例ACS组患者分为不良心血管事件(MACEs)组(n=15)和非MACEs组(n=43),比较不同预后患者CCTA斑块特征参数。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。采用Pearson相关分析血脂水平与斑块特征参数的相关性。采用受试者工作特征曲线(ROC)分析斑块特征参数对ACS及MACEs的预测价值。结果ACS组患者斑块长度、NCP体积和NCP负荷均显著高于SAP组,差异有统计学意义(P<0.05)。MACEs组患者斑块长度、NCP体积和NCP负荷均显著高于非MACEs组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,血清低密度脂蛋白胆固醇(LDL-C)与斑块长度、CP体积、NCP体积、总斑块体积、CP负荷、NCP负荷及总斑块负荷呈正相关(r=0.463,0.246,0.414,0.292,0.251,0.392,0.215;P<0.05)。ROC曲线分析结果显示,斑块长度、NCP体积、NCP负荷对ACS有较好的预测价值,曲线下面积(AUC)分别为0.843(95%CI 0.761~0.925)、0.814(95%CI 0.703~0.926)和0.721(95%CI 0.573~0.869);发生ACS的最佳截断值分别为19.19 mm、152.99 mm 3和42.56%;灵敏度分别为91.67%、91.67%和66.67%;特异度分别为75.00%、63.54%和77.08%。斑块长度、NCP体积、NCP负荷对MACEs有较好的预测价值,AUC分别为0.694(95%CI 0.515~0.876)、0.711(95%CI 0.502~0.920)和0.735(95%CI 0.551~0.919);发生MACEs的最佳截断值分别为21.02 mm、169.62 mm 3和45.37%;灵敏度分别为77.78%、66.67%和88.89%;特异度分别为59.18%、85.71%和61.22%(P<0.05)。结论基于CCTA的斑块特征参数不仅对老年ACS有较好的鉴别作用,还可有效预测ACS患者1年内MACEs的发生。