CAJ | 학술논문

目的：探讨双源CT血管成像检查(DSCTA)在 Stanford B型主动脉夹层(AD)诊断及血管腔内隔绝(EVE)术后随访中的临床价值。方法63例患者经 DSCTA检查诊断为 Stanford B型 AD,其中24例 EVE术后行 DSCTA随访观察。在工作站上完成图像后处理及分析工作。全面观察夹层相关CT表现,测量动脉期真、假腔的强化 CT值,测量初始破口位于弓降部者近端瘤颈的长度及宽度、瘤体最大直径。EVE治疗者重点观察夹层的转归及并发症情况。结果 DSCTA 准确显示了63例夹层累及范围、破口位置、真假腔及撕裂内膜片形态、主动脉大分支受累情况,动脉期真腔平均强化 CT值高于假腔(P=0.000)。60例初始破口位于弓降部患者,近端瘤颈长度0.3~9.6 cm(平均3.4 cm)、瘤颈宽度2.3~3.8 cm(平均2.9 cm)、瘤体最大径3.1~9.0 cm(平均5.3 cm)。24例 EVE治疗患者瘤体均未见继续扩大,11例假腔缩小,多数患者假腔内血栓增加,11例支架内漏发生。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 Stanford B型 AD诊断及 EVE术后随访的重要手段。
목적：탐토쌍원CT혈관성상검사(DSCTA)재 Stanford B형주동맥협층(AD)진단급혈관강내격절(EVE)술후수방중적림상개치。방법63례환자경 DSCTA검사진단위 Stanford B형 AD,기중24례 EVE술후행 DSCTA수방관찰。재공작참상완성도상후처리급분석공작。전면관찰협층상관CT표현,측량동맥기진、가강적강화 CT치,측량초시파구위우궁강부자근단류경적장도급관도、류체최대직경。EVE치료자중점관찰협층적전귀급병발증정황。결과 DSCTA 준학현시료63례협층루급범위、파구위치、진가강급시렬내막편형태、주동맥대분지수루정황,동맥기진강평균강화 CT치고우가강(P=0.000)。60례초시파구위우궁강부환자,근단류경장도0.3~9.6 cm(평균3.4 cm)、류경관도2.3~3.8 cm(평균2.9 cm)、류체최대경3.1~9.0 cm(평균5.3 cm)。24례 EVE치료환자류체균미견계속확대,11례가강축소,다수환자가강내혈전증가,11례지가내루발생。결론DSCTA검사구유조작간편、준학성고차무창등우점,가이작위 Stanford B형 AD진단급 EVE술후수방적중요수단。
Objective To investigate clinical value of dual-source CT angiography (DSCTA)in diagnosis and following-up obser-vation after endovascular exclusion (EVE)of Stanford type B aortic dissection (AD).Methods 63 cases with type B aortic dissection were diagnosed by DSCTA,and 24 cases among these cases underwent EVE were following-up observed by DSCTA.Imaging recon-struction and analysis were finished at special workstation.All CT findings of dissection were carefully observed in every case,CT values of true and false lumens were measured at arterial-phase.The length and the width of proximal neck,and the maximum di-ameter of AD were measured in those cases that initial crevasse located at aortic arch or proximal descending thoracic aorta.The out-comes and complications of 24 cases underwent EVE were focused.Results The extension of dissection,the site of crevasse,mor-phological features of true and false lumens and tearing intimal flap,and involving main branches of aorta were accurately shown by DSCTA.Average CT value of true lumen was higher than false lumen at arterial-phase in all cases (P=0.000).In 60 cases that ini-tial crevasse located at aortic arch or proximal descending thoracic aorta,the length and the width of proximal neck of dissection changed from 0.3 cm to 9.6 cm(average 3.4 cm)and from 2.3 cm to 3.8 cm(average 2.9 cm)respectively,and the maximum di-ameter of AD was between 3.1 cm and 9.0 cm(average 5.3 cm).AD after EVE did not unceasingly enlarge in all 24 cases,false lu-men shrinked in 1 1 cases,thrombus in false lumen added in most cases,stent endoleaking were observed in 1 1 cases.Conclusion DSCTA with convenient,effective and non-invasive advantages,is one of important imaging methods in diagnosis and following-up observation after EVE of type B aortic dissection.