超声及CTA对主动脉夹层Stanford细化分型的诊断价值

目的探讨超声、计算机体层摄影血管造影（computed tomography angiography,CTA）及两者联合对主动脉夹层Stanford细化分型的诊断价值。方法对128例高度怀疑主动脉夹层的患者分别进行超声和CTA检查,并依据Stanford细化分型做出诊断,该分型包括A1、A2、A3型和B1、B2、B3型,其中每个亚型又包括S和C两个亚级;以手术结果为金标准,分别评价超声、CTA及两者联合对主动脉夹层Stanford细化分型的诊断价值。结果[1]术前超声、CTA及两者联合对夹层细化分型诊断的敏感性分别为76.5%、91.3%、100%;特异性分别为34.5%、0%、34.5%;准确性分别为72.7%、82.0%、93.8%;阳性预测值分别为91.7%、89.0%、93.5%;阴性预测值分别为15.6%、0%、100%;于超声对A1S、A2S、A3S诊断准确率为100%,而对B3C容易漏诊;CTA对A1S、A1C以及所有B亚型诊断准确率为100%,而对A2S、A2C容易误诊;两者结合能明显提高细化分型诊断的准确率。结论超声及CTA对主动脉夹层Stanford细化分型诊断具有重要的诊断价值,两者联合能明显提高诊断的敏感度、准确度、阳性预测值及阴性预测值。

Application of ultrasound and computed tomography angiography in the aortic dissection depending on the modified Stanford classification system

Objective To evaluate the value of ultrasound and ultrasound combined with CTA in the assessment for modified Stanford classification system of aortic dissection. Methods Totally 128 cases of highly suspected acute dissection patients have been enrolled and examined by ultrasound and CTA respectively, and have been classified depending on the modified Stanford classification system. The modified Stanford classification system of aortic dissection includes the types of A1, A2, A3 and B1, B2, B3, which also includes two subtypes of S and C. According to the surgical findings, the diagnostic efficiency of ultrasound, CTA and combining both in the assessment for modified Stanford classification system of acute aortic dissection have been evaluated. Results The preoperative diagnostic sensitivity of ultrasound, CTA and combination of both in the assessment for modified Stanford classification system of acute aortic dissection is 76. 5%, 91. 3% and 100%, respectively;the specificity is 34. 5%, 0. 0% and 34. 5% respectively; the accuracy is 72. 7%, 82. 0% and 93. 8%respectively;the positive predictive value is 91. 7%, 89. 0% and 93. 5% respectively;the negative predictive value is 15. 6%, 0. 0% and 100% respectively. The accuracy of diagnosing the subtypes A1S, A2S and A3S are 100% by ultrasound, but the subtype B3C is easily missed diagnosis;A1S, A1C and all subtypes of B by CTA were 100%, but for A2S and A2C were easily misdiagnosed. Combining ultrasound with CTA can increase the diagnostic accuracy significantly. Conclusion There are great value of ultrasound and CTA in clinical practice for assessment of modified Stanford classification of acute dissection, and combining ultrasound with CTA will contribute to increase significantly the sensitivity, accuracy, the positive predictive and the negative predictive value.