临床和实验医学杂志
臨床和實驗醫學雜誌
림상화실험의학잡지
Journal of Clinical and Experimental Medicine
2015年
18期
1554-1557
,共4页
主动脉夹层动脉瘤%多层螺旋 CT%血管成像技术%诊断性能%应用价值
主動脈夾層動脈瘤%多層螺鏇 CT%血管成像技術%診斷性能%應用價值
주동맥협층동맥류%다층라선 CT%혈관성상기술%진단성능%응용개치
Aortic dissection aneurysm%Multi - slice spiral CT%Vascular imaging%Diagnostic performance%Value for application
目的：探析多层螺旋 CT（MSCT）血管成像技术（CTA）在主动脉夹层动脉瘤（AD）中的诊断性能及临床应用价值。方法回顾性分析68例确诊为 AD 患者的临床资料，均行64排 MSCTA 检查，利用智能追踪技术进行容积增强扫描，并对原始数据进行多平面重建、曲面重建、对打密度投影、三维容积成像、仿真内镜图像后处理，容积再现技术进行重建，分析真假腔、内膜瓣、破口显示情况。结果68例 AD 患者中 Stanford A 型21例、B 型47例；AD 真腔组平均强化值279.00±46.55 HU 明显高于假腔组平均强化值260.06±49.59 HU，差异有统计学意义（ t ＝2.2963，P ＝0.0232）；66例（97.06%）AD 患者明确可见第一破口，60例（88.24%）存在再破口；42例真腔强化值大于假腔强化值者第一破口大小为12.05±6.48 mm 明显小于26例真腔强化值与假腔强化值相近者内膜第一破口大小19.08±8.56 mm（ t＝3.8394，P ＝0.0003）；60例 AD 患者真假腔呈螺旋形走行、8例呈平行状走行，真假腔大小不一；68例夹层内膜瓣增强扫描均清楚显示，走行和真假腔一致。双侧髂总动脉最易受累。多平面重建（ MPR）、曲面重建（ CPR）、仿真内镜（CTVE）、容积再现技术（VR）对破口显示率分别为92.65%、95.59%、79.41%、23.53%，最大强度投影（MIP）不显示破口，破口显示率差异有显著统计学意义（χ2＝116.2108，P ＝0.0000）；MPR、CPR、CTVE、VR 对内膜瓣的显示率分别为100.00%、100.00%、89.71%、97.06%，MIP 不显示内膜瓣，内膜瓣显示率差异有显著统计学意义（χ2＝15.0537，P＝0.0018）；MPR、MIP、CPR、CTVE、VR 对真假腔显示率分别为95.59%、77.94%、97.06%、95.59%、100.00%，真假腔显示率差异有显著统计学意义（χ2＝32.9228，P ＝0.0000）。结论64排 MSCTA 能快速、安全、准确地诊断 AD，为手术或者血管腔内隔绝术提供立体及精确的解剖信息，故 MSCTA 可作为 AD 首选的影像学检查方法。
目的：探析多層螺鏇 CT（MSCT）血管成像技術（CTA）在主動脈夾層動脈瘤（AD）中的診斷性能及臨床應用價值。方法迴顧性分析68例確診為 AD 患者的臨床資料，均行64排 MSCTA 檢查，利用智能追蹤技術進行容積增彊掃描，併對原始數據進行多平麵重建、麯麵重建、對打密度投影、三維容積成像、倣真內鏡圖像後處理，容積再現技術進行重建，分析真假腔、內膜瓣、破口顯示情況。結果68例 AD 患者中 Stanford A 型21例、B 型47例；AD 真腔組平均彊化值279.00±46.55 HU 明顯高于假腔組平均彊化值260.06±49.59 HU，差異有統計學意義（ t ＝2.2963，P ＝0.0232）；66例（97.06%）AD 患者明確可見第一破口，60例（88.24%）存在再破口；42例真腔彊化值大于假腔彊化值者第一破口大小為12.05±6.48 mm 明顯小于26例真腔彊化值與假腔彊化值相近者內膜第一破口大小19.08±8.56 mm（ t＝3.8394，P ＝0.0003）；60例 AD 患者真假腔呈螺鏇形走行、8例呈平行狀走行，真假腔大小不一；68例夾層內膜瓣增彊掃描均清楚顯示，走行和真假腔一緻。雙側髂總動脈最易受纍。多平麵重建（ MPR）、麯麵重建（ CPR）、倣真內鏡（CTVE）、容積再現技術（VR）對破口顯示率分彆為92.65%、95.59%、79.41%、23.53%，最大彊度投影（MIP）不顯示破口，破口顯示率差異有顯著統計學意義（χ2＝116.2108，P ＝0.0000）；MPR、CPR、CTVE、VR 對內膜瓣的顯示率分彆為100.00%、100.00%、89.71%、97.06%，MIP 不顯示內膜瓣，內膜瓣顯示率差異有顯著統計學意義（χ2＝15.0537，P＝0.0018）；MPR、MIP、CPR、CTVE、VR 對真假腔顯示率分彆為95.59%、77.94%、97.06%、95.59%、100.00%，真假腔顯示率差異有顯著統計學意義（χ2＝32.9228，P ＝0.0000）。結論64排 MSCTA 能快速、安全、準確地診斷 AD，為手術或者血管腔內隔絕術提供立體及精確的解剖信息，故 MSCTA 可作為 AD 首選的影像學檢查方法。
목적：탐석다층라선 CT（MSCT）혈관성상기술（CTA）재주동맥협층동맥류（AD）중적진단성능급림상응용개치。방법회고성분석68례학진위 AD 환자적림상자료，균행64배 MSCTA 검사，이용지능추종기술진행용적증강소묘，병대원시수거진행다평면중건、곡면중건、대타밀도투영、삼유용적성상、방진내경도상후처리，용적재현기술진행중건，분석진가강、내막판、파구현시정황。결과68례 AD 환자중 Stanford A 형21례、B 형47례；AD 진강조평균강화치279.00±46.55 HU 명현고우가강조평균강화치260.06±49.59 HU，차이유통계학의의（ t ＝2.2963，P ＝0.0232）；66례（97.06%）AD 환자명학가견제일파구，60례（88.24%）존재재파구；42례진강강화치대우가강강화치자제일파구대소위12.05±6.48 mm 명현소우26례진강강화치여가강강화치상근자내막제일파구대소19.08±8.56 mm（ t＝3.8394，P ＝0.0003）；60례 AD 환자진가강정라선형주행、8례정평행상주행，진가강대소불일；68례협층내막판증강소묘균청초현시，주행화진가강일치。쌍측가총동맥최역수루。다평면중건（ MPR）、곡면중건（ CPR）、방진내경（CTVE）、용적재현기술（VR）대파구현시솔분별위92.65%、95.59%、79.41%、23.53%，최대강도투영（MIP）불현시파구，파구현시솔차이유현저통계학의의（χ2＝116.2108，P ＝0.0000）；MPR、CPR、CTVE、VR 대내막판적현시솔분별위100.00%、100.00%、89.71%、97.06%，MIP 불현시내막판，내막판현시솔차이유현저통계학의의（χ2＝15.0537，P＝0.0018）；MPR、MIP、CPR、CTVE、VR 대진가강현시솔분별위95.59%、77.94%、97.06%、95.59%、100.00%，진가강현시솔차이유현저통계학의의（χ2＝32.9228，P ＝0.0000）。결론64배 MSCTA 능쾌속、안전、준학지진단 AD，위수술혹자혈관강내격절술제공입체급정학적해부신식，고 MSCTA 가작위 AD 수선적영상학검사방법。
Objectine To explore the diagnostic performance and clinical significance of multi - slice spiral CT(MSCT)angiography and computed tomography angiography(CTA)in diagnosis of aortic dissecting aneurysm. Methods The Clinical data of 68 cases diagnosed with aor-tic dissections(AD)were retrospectively analyzed. All these patients were examined with 64 - detector CTA using intelligent tracking technique for rapid volume enhanced scanning,and primary data were processed with multiplannar reformation( MPR),curved plannar reconstruction (CRP),the maximum intensity projection(MIP),volume representation technical reconstruction(VR),CT virtual endoscopy(CTVE)and vol-ume representative technical reconstruction(VR). The true and false lumens,intimal flap and tears were analyzed. Results There were 21 cases with Stanford A type,and 47 cases with B type;the average strengthening value of AD in true lumen group(279. 00 ± 46. 55 HU)was significant-ly higher than the average strengthening value of false lumen group(260. 06 ± 49. 59 HU,t = 2. 2963,P = 2. 2963). It could be seen in 66 ca-ses(97. 06% )of first tear and 60 cases(88. 24% )of re - entry tears. In 42 cases of true lumen value which strengthening value was greater than that of false lumen,the first tear size was 12. 05 ± 6. 48 mm,which was much smaller than the size of first tear(19. 08 ± 8. 56 mm,t = 3. 8394, P = 3. 8394)in 26 cases with true lumen,in which strengthening value was almost the same to that of false lumen. The true and false lumens of 60 patients with AD were spirally contorted,another 8 cases were parallel contortion,their size was differed. Enhanced scanning of 68 patients showed mezzanine intimal flap was clearly performed,and the movement was in accordance with that of true and false lumens. Bilateral common il-iac arteries were most easily affected. The rates of breach in MPR,CPR,CTVE and VR were 92. 65% ,95. 59% ,79. 41% and 23. 53% respec-tively,MIP did not display the tear. The screen resolution of tear showed significant statistical difference(χ2 = 116. 2108,P = 116. 2108). The rates of screen resolution of intimal flap in MPR,CPR,CTVE and VR were 100. 00% ,100. 00% ,89. 71% and 97. 06% respectively,MIP did not display the intimal flap,and it showed significantly statistical difference(χ2 = 15. 0537,P = 15. 0537). The rates for screen resolution of true and false lumens in MPR,MIP,CPR,CTVE and VR were 95. 59% ,77. 94% ,97. 06% ,95. 59% and 97. 06% respectively,and their differ-ence was statistically significant(χ2 = 32. 9228,P = 32. 9228). Conclusion AD can be quickly,safely and accurately diagnosed by 64 - de-tector spiral CTA,which can provide three - dimensional and accurate anatomic information for operation or endovascular stent - graft exclusion, hence it is the first choice of imaging method for detecting AD.
