CAJ | 학술논문

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。
목적：탐토 DSCTA(dual-source CT angiography, DSCTA)검사재복주동맥류(abdominal aortic aneurysm, AAA)진단급강내지가격절( endovascular stent-graft exclusion,EVE)술후수방중적림상개치。방법86례환자경DSCTA검사진단위AAA,기중16례신하형환자EVE술후행DSCTA수방。재공작참상완성환자적도상후처리급분석공작,중건기술포괄다평면중조( MPR)、최대밀도투영( MIP)급용적재현기술( VRT)등。 AAA환자중점관찰AAA적류형、부위、대소、루급범위,병안조강내격절술적요구대신하형AAA진행상관삼수측량병분형；행EVE치료환자중점관찰AAA적전귀급병발증정황。결과①86례환자포괄4례신상형、82례신하형。②의거강내격절술적요구,82례신하형환자분위Ⅰ형9례、ⅡA형6례、ⅡB형12례、ⅡC형42례、Ⅲ형13례。③DSCTA도상능준학현시매위환자류체적형태、부위、대소,여주동맥중요분지혈관적관계급부벽혈전,능준학측량AAA적상관수거。④16례EVE치료환자술후AAA균불동정도축소혹보지은정,지가복개구지가외류체균기본혈전화、내막하미견혈전형성。12례복주동맥내지가형태정상、4례지가초변형。소유환자균미견지가내루발생。결론 DSCTA검사구유조작간편、준학성고차무창등우점,가이작위AAA진단여감측、술전평개급EVE술후수방적중요영상학공구。
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 in-tensity 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 re-nal artery were classified as 9 typeⅠ, 6 typeⅡA, 12 typeⅡB, 42 typeⅡC and 13 typeⅢ.③DSCTA images clearly displayed shape, locality and size of aneurysm, and anatomic relation between aneurysm body and adjacent main branches of aorta, and mu-ral thrombus in all patients. Furthermore, relative data of AAA could also be accurately measured on CTA images. ④The 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.