血管内超声显像在诊断主动脉夹层动脉瘤中的应用

目的　评价血管内超声 (IVUS)显像在诊断主动脉夹层动脉瘤中的作用。　方法　选择血管外科收治的主动脉夹层动脉瘤患者 82例。评价IVUS在明确夹层真假腔、破口位置、末端部位、假腔内血栓、内脏动脉与真假腔的关系、内脏动脉的缺血原因和主动脉直径等方面的作用 ,并与CT、MRI、经胸超声 (TTE)、经食管超声 (TEE)、双功能超声 (Duplex)和动脉造影 (DSA)相对照。结果　通过IVUS发现的真假腔外侧壁的超声结构差异、真假腔外侧壁交界处的特征性改变和假腔内血栓可鉴别真假腔。IVUS可发现静态狭窄和动态狭窄等内脏动脉缺血的原因。IVUS对近端破口的检出率为 1 0 0 % ,高于CT(2 8% )、MRI(2 2 % )、TTE(2 % )和TEE(61 % ) (P <0 0 1 ) ;与DSA(88% )差异无显著性意义 (P >0 0 5)。IVUS对夹层末端的检出率为 1 0 0 % ,高于Duplex(2 1 % ) (P <0 0 1 ) ;与CT(89% )和MRI(86 % )差异无显著性意义 (P >0 0 5)。IVUS对内脏动脉的检出率为 98% ,高于CT(56 % )、MRI(57% )、Duplex(1 7% )和DSA(66 % ) (P <0 0 1 )。IVUS测得的主动脉直径与CT测量值的相关系数r=0 94(P <0 0 1 )。　结论　应用IVUS能够对主动脉夹层动脉瘤的全貌有比较全面的认识。在明确内脏动脉与真假腔的关系和内脏动脉的缺血原因方面 ,IVUS优

The application of intravascular ultrasound imaging in the diagnosis of aortic dissection

Objective To evaluate the role of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic dissection. Methods Eighty two patients with aortic dissection were admitted. The role of IVUS was evaluated and compared with CT, MRI, transthoracic echocardiography (TTE), transesophegeal echocardiography (TEE), Duplex scanning and digital subtraction angiography (DSA). Results The different laminar appearance of the outer wall of the true and false lumen, characteristic alterations in the true and false lumen junction and the thrombosis in the false lumen detected by IVUS were useful to differentiate the true from the false lumen. Static and dynamic narrowing, causing visceral ischemia could be detected by IVUS imaging. The detection rate of entry site by IVUS was 100%, higher than CT (28%), MRI (22%), TTE (2%) and TEE (61%), P <0 01, having no statistic difference with DSA (88%). The detection rate of the distal end of the dissection by IVUS was 100%, higher than Duplex (21%), P <0 01, but had no statistic difference as compared with CT (89%) and MRI (86%). The detection rate of visceral arteries by IVUS was 98%, higher than CT (56%), MRI (57%), Duplex (17%) and DSA (66%), P <0 01. The aortic diameter measured by IVUS was correlated well with CT measurement ( r =0 94, P <0 01). Conclusions A full picture of aortic dissection can be obtained using IVUS imaging. It has an advantage over routine examinations in detecting visceral artery origin and clarifying visceral ischemia causes.