主动脉夹层磁共振诊断与超声等诊断方法的比较

目的　评价和比较MRI、综合超声、CT、X线血管造影在主动脉夹层中的价值 ,探讨主动脉夹层的影像学综合诊断及其优选应用。方法　 62例主动脉夹层均进行MRI的自旋回波 (SE)序列、电影 (Cine MRI)和经胸超声 (TTE)检查 ,其中 3 2例行二维磁共振造影 (2D MRA)检查 ,2 0例行三维动态增强磁共振造影 (3D DCEMRA )检查 ,2 3例行速度编码电影血流速度测定 (VEC)检查 ,15例行经食道超声 (TEE)检查。 3 3例行螺旋CT检查 ,2 9例行DSA检查并进行比较研究。结果　MRI和TTE对主动脉夹层诊断的灵敏度分别是 97%、85 % ,特异度分别为 10 0 %、90 %。TEE诊断主动脉夹层的灵敏度为 10 0 % ,CT灵敏度为 90 .1% ,DSA灵敏度为 89.6%。结论　MRI和综合超声及CT、DSA均为诊断主动脉夹层的优良方法 ,应根据不同的情况加以选择 ,而MRI应为首选     

急诊主动脉夹层超声心动图和多层螺旋CT诊断对比分析

目的探讨超声心动图和多层螺旋CT在急诊主动脉夹层中的诊断价值。方法 51例经临床及经胸超声心动图(TTE)诊断为AD的患者进行多层螺旋CT(MSCT)检查,与手术结果进行对照。结果 TTE诊断符合率为92.2%(47/51),其中Debakey I型诊断符合率为100%(29/29)。MSCT诊断符合率100%(51/51),两者比较差异无统计学意义(P>0.05)。TTE评估主动脉弓部是否受累诊断符合率94.6%(35/37),MSCT诊断符合率100%(37/37),两者比较差异无统计学意义(P>0.05)。TTE评估主动脉瓣结构及功能受累程度诊断准确度优于MSCT,两者比较差异有统计学意义(P<0.05);而MSCT评估胸、腹主动脉分支血管及冠状动脉受累程度诊断准确度优于TTE,两者比较差异有统计学意义(P<0.05)。结论 TTE作为一种无创性心血管检查,其便利、重复性强,可准确诊断AD及其分型、主动脉弓部是否受累、主动脉瓣受累程度,而MSCT可进一步明确胸、腹主动脉分支血管及冠状动脉受累程度。     

CT联合MRI对脑梗死患者诊断效能的影响

目的:探讨CT联合MRI在脑梗死患者中诊断价值。方法:选取我院2015年10月—2017年9月拟诊脑梗死患者63例,均行CT及MRI检查,统计比较CT、MRI及联合检查诊断准确率、灵敏度、特异度及误诊率、漏诊率,并观察联合诊断与CT诊断对不同发病时间(24 h、24～72 h、72 h)脑梗死检出率。结果:CT+MRI诊断准确率为90.48%(57/63)、灵敏度为98.04%(50/51),均高于CT、MRI各单一诊断;漏诊率为1.96%(1/51)低于CT、MRI各单一诊断,差异具有统计学意义(P0.05);CT+MRI对发病时间不足24 h脑梗死患者检出率为35.29%(18/51),高于CT单一诊断15.69%(8/51),差异具有统计学意义(P0.05)。结论:CT联合MRI应用于脑梗死,诊断准确率高、灵敏度高,漏诊率低,可提高早期脑梗死检出率。     

MSCT联合TTE对早期主动脉夹层患者诊断准确率的影响

目的:分析多层螺旋CT(MSCT)联合经胸超声心动图(TTE)对早期主动脉夹层(AD)患者诊断准确率的影响。方法:选取我院收治的手术结果证实为AD患者46例。术前均行MSCT、TTE检查。统计对比MSCT、TTE单一与联合检查诊断准确率。结果:联合诊断准确率为95.65%(44/46),高于TTE 71.74%(33/46)、MSCT80.43%(37/46),差异均有统计学意义(X~2=9.382、P=0.009);MSCT、TTE单一与联合检查De Bakey I型诊断率均较高,而TTE对De BakeyⅢ诊断率最低。结论:MSCT联合TTE检查可提高早期主动脉夹层患者诊断准确率,临床应用价值较高。     

多层螺旋CT血管造影应用于Stanford B型主动脉夹层的诊断意义分析

目的:分析Stanford B型主动脉夹层诊断中多层螺旋CT血管造影的应用价值。方法:分析研究入院主动脉夹层患者基本资料,将其中的62例作为本次研究样本,分别予以多层螺旋CT血管造影(MSCTA)检查和数字减影血管造影(DSA)检查,对比诊断相关数据。结果:MSCTA检出破口检出率为87.10%,与DSA检出率差异不明显(χ²=1.480,P=0.477);MSCTA破口平面主动脉直径为(28.49±6.42)mm,与DSA的(27.81±6.23)mm无明显差异(t=0.599,P=0.551);就影像学表现来看,DSA检测以线样征主动脉夹层最多(46.77%),MSCTA检测以双腔征主动脉夹层最多(43.55%),对数据进行统计学分析,两组各影像学表现检出率无明显差异(P>0.05);将DSA作为金标准,MSCTA在Stanford B型主动脉夹层中的特异度为78.26%、敏感度为89.74%、准确度为85.48%。结论:在Stanford B型主动脉夹层诊断中,多层螺旋CT血管造影具有较高的准确率和敏感性,且安全无创,具有应用和推广价值,可作为优先选择...     

X线、CT、MRI对主动脉夹层的诊断价值及影像学比较

目的探讨主动脉夹层（AD）的普通X线、CT、磁共振成像（MRI）影像表现及三种检查方法的诊断价值。方法对25例主动脉夹层的x线、CT与MRI所见,以及三项检查技术进行汇总并对比分析。结果普通x线提示性阳性率68％（17／25）;CT阳性率100％（25／25）,破裂口检出率28／％（7／25）;MRI检查7例,7阳性率100％（7／7）,破裂口检出6例。普通x线Y对AD检出率低,CT对内膜破口及夹层范围诊断有一定限度,MRI对内膜钙化内移显示率低。三者对内膜片及双腔显示率由高到低依次为MRI、CT、普通x线。依次为。结论普通x线是AD的初步排查方法,CT和MRI是诊断AD首选方法。     

超声心动图诊断DebakeyⅠ型主动脉夹层的临床意义

目的 探讨经胸超声心动图(transthoracic echocardiography,TTE)对主动脉夹层(aortic dissection,AD)诊断的临床意义.方法 应用TTE动态测量主动脉内径、观察主动脉及其分支动脉内膜分离的部位和范围,鉴别真假腔,观察主动脉瓣反流情况,评价心功能,测量心包积液,并与MRI、多层螺旋CT血管成像术(MSCTA)及主动脉数字减影血管造影术(DSA)进行比较分析.结果 TTE对主动脉夹层的诊断较可靠,可动态观察AD进展情况,能更好地查出主动脉瓣反流程度、检测心功能、测量心包积液,及时为临床提供患者病情变化信息.较其他影像检查,具有无创、重复性强、轻便易移动、费用低的优势.结论 TTE对AD的诊断具有较大临床意义,是一种理想的随诊方法.     

主动脉夹层动脉瘤4种放射影像学比较分析

目的 分析4种放射影像学检查方法对主动脉夹层动脉瘤(DAA)的诊断价值.方法 将71例主动脉夹层动脉瘤患者的X线平片、64层螺旋CT、MRI、DSA检查结果汇总,并进行评价分析.结果 DAA的检出:X线平片提示阳性率为52.11%,64层螺旋CT阳性率为94.37%(MRI阳性率为100%),DSA阳性率为100%;DAA破裂口的检出:64层螺旋CT检出率81.69%,DSA1检出率93.75%,MRI检出率为85.00%,X线平片单独未检测出破裂口.结论 64层螺旋CT、MRI、DSA对主动脉夹层动脉瘤的临床诊断均有较高的价值,但DSA和MRI存在有一定的缺点,常规X线胸片对该病特异性不强,可仅可作为初检检测手段.     

急诊TTE联合多层螺旋CT在主动脉夹层诊断中的应用价值分析

目的:分析急诊TTE联合多层螺旋CT在主动脉夹层诊断中的应用价值。方法:选取我院急诊主动脉夹层患者55例(2016年1月至2019年5月),患者均进行TTE检查与多层螺旋CT检查,观察患者检查结果。结果:联合诊断检出53例,准确率96.36%,TTE检查检出42例,准确率76.36%,P<0.05,多层螺旋CT检查检出46例,准确率83.64%,与联合诊断对比,P<0.05,联合诊断破裂口检出率53例,检出率96.36%,高于单纯TTE检查与单纯多层螺旋CT检查,P<0.05,联合诊断心包积液检出19例,检出率100.00%,血栓检出24例,检出率96.00%,高于单纯TTE检查,P<0.05。结论:在急诊主动脉夹层诊断中应用TTE联合多层螺旋CT诊断,能提高诊断准确率,对患者进行快速准确的定位、定性诊断,值得借鉴。     

经胸超声心动图诊断主动脉夹层的准确率分析

目的:分析经胸超声心动图诊断主动脉夹层的准确率。方法:选取2022年1月—2023年6月就诊于北京市石景山医院的50例疑似主动脉夹层患者。所有患者分别独立完成经胸超声心动图(TTE)与CT血管造影(CTA)检查。以CTA检查结果作为金标准,分析TTE诊断结果以及Stanford分型结果的准确率。基于CTA检查结果将患者分为主动脉夹层组与非主动脉夹层组,对比TTE检测的主动脉内径;统计经CTA确诊的主动脉夹层患者的TTE间接征象。结果:TTE诊断准确率为90.00%,与CTA诊断一致性良好(Kappa值=0.795)。TTE对主动脉根部、升主动脉、弓部动脉以及降主动脉近端的异常检出率与CTA差异无统计学意义(P> 0.05);TTE对降主动脉远端及腹部动脉的异常检出率低于CTA,差异有统计学意义(P <0.05)。TTE对Stanford分型诊断的准确率为88.00%,与CTA诊断、一致性尚可(Kappa值=0.733)。基于CTA检查结果将患者分为主动脉夹层组与非主动脉夹层组,主动脉夹层组的主动脉内径大于非主动脉夹层组,差异有统计学意义(P <0.05)。29例患者经...     

Comparison of conventional and transesophageal echocardiography with magnetic resonance imaging for anatomical mapping of thoracic aortic dissection

Thirty-five consecutive patients with clinically suspected aortic dissection were subjected to a dual noninvasive imaging protocol using comprehensive echocardiography and ECG-triggered MRI with multi-slice spin echo and cine sequences in random order. The purpose of this dual imaging study was to compare the diagnostic accuracy of two-dimensional and color-coded Doppler echocardiography using the conventional transthoracic (TTE) and the transesophageal approach (TEE) with magnetic resonance imaging (MRI) for the exact morphologic evaluation and anatomical mapping of the thoracic aorta. The results of each diagnostic method were validated independently against the ‘gold standard’ of intraoperative findings (n=17), necropsy (n=4) or contrast angiography (n=22). Compared to conventional transthoracic echocardiography both TEE and MRI were more reliable in detecting aortic dissections (TTE vs TEE: p<0.02; TTE vs MRI: p<0.01) and associated epiphenomena. Moreover, the reliability of TTE decreased significantly from proximal to distal segments of the aorta, e.g. from the ascending segment to the arch (p<0.05) and to the descending aorta (p<0.005), whereas the sensitivities of both TEE and MRI were excellent irrespective of the site of dissection. With regard to epiphenomena such as thrombus formation and entry location, MRI emerged as the optimal method for detailed morphologic information in all segments of the aorta. No serious side effects were encountered with either method. Thus, in patients with suspected acute or subacute aortic dissections the echocardiographic assessment should include the transesophageal approach for significant improvement of the moderate sensitivity and specificity of TTE. Both TEE and MRI are non-traumatic, safe and diagnostically accurate to identify and classify acute and subacute dissections of the thoracic aorta irrespective of their location. MRI provides superb anatomical mapping of all type A and B dissections and more detailed information on the site of entry and thrombus formation than TEE. These features of TEE and MRI may render retrograde contrast angiography obsolete in the setting of thoracic aortic dissection and may encourage surgical interventions exclusively on the basis of noninvasive imaging.     

主动脉夹层的超声心动图诊断及与其他影像诊断的比较

目的 探讨经胸超声心动图（ＴＴＥ）、经食管超声心动图（ＴＥＥ）对主动脉夹层的诊断价值。并与磁共振影像（ＭＲＩ）、超高速ＣＴ）ＵＦＣＴ）等影像诊断进行比较。方法 对１３９例经手术证实的主动脉夹层患者临床资料进行分析。对照手术结果,评价超声心动图诊断主动脉夹层ＤｅＢａｋｅｙ分型以及并发症的准确性,并与ＭＲＩ、ＵＦＣＴ诊断结果进行比较,结果 ＴＴＥ、ＴＥＥ、ＵＦＣＴ、ＭＲＩ对主动脉夹层的诊断率分别为８９     

Magnetic resonance imaging features of aortic diseases

The usefulness of magnetic resonance imaging (MRI) for aortic diseases is discussed, with special attention given to the MRI features of aortic dissection and Takayasu arteritis. Computed tomography (CT) and MRI provide excellent visualization of vessels and their relationship to surrounding structures; however, CT depicts the vessel lumen optimally only when contrast enhancement is used. MRI, with its inherent multiplanar imaging capability, is well suited for evaluation of the thoracic and abdominal aorta and can be used with or without contrast enhancement. Basic technical considerations in cardiac imaging, which include conventional spin-echo, fast spin-echo, cine gradient, and echo-planar imaging, with time-of-flight and phase-contrast methods, are discussed and applied to aortic aneurysm, aortic dissection, and Takayasu arteritis. The diagnostic capacity of spin-echo MRI in patients with suspected aortic dissection is enhanced when it is combined with cine MRI. Despite the ability of CT and MRI to demonstrate luminal and mural changes of aortic abnormalities, conventional angiography still may be necessary at first admission for selected patients in the late occlusive phase to provide additional information on the degree and extent of the arteritis. CT angiography and MR angiography are promising imaging techniques that will overcome difficulties in visualizing distal branch vessel lesions and obviate the need for conventional angiography in the near future.     

Dissection of the proximal thoracic aorta: a new ultrasonographic sign in the subxiphoid view

Dissection of the thoracic aorta is a life-threatening event that presents with some regularity to emergency departments (EDs). Despite often nonspecific symptoms, it is critical to catch this disease process early, especially when the proximal aorta is involved because dissections involving the aortic root can lead to myocardial infarction and failure of the aortic valve resulting in death. Current imaging options include contrast-enhanced chest computed tomography (CT), angiography, magnetic resonance imaging, or transesophageal echocardiography. Although not as accurate as transesophageal echocardiography, transthoracic echocardiography (TTE) can be used to detect aortic dissection as well. We present a previously undescribed echocardiographic finding associated with proximal dissection of the thoracic aorta in 7 cases.     

Role of computed tomography and magnetic resonance imaging in assessment of acute aortic syndromes

Acute aortic syndromes refer to the spectrum of aortic emergencies that include nontraumatic diseases of the aorta, such as aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aortic aneurysm leak, as well as traumatic aortic transection. Patients presenting with nontraumatic acute aortic syndromes usually have a similar clinical profile; hence, clinical diagnosis is difficult. Computed tomography (CT) and magnetic resonance imaging (MRI) allow for specific diagnosis of the underlying condition. Traumatic rupture of the aorta is one of the most dreaded complications of blunt chest trauma; therefore, in patients with high-risk deceleration injuries, radiographic assessment of the aorta is crucial. Imaging methods should detect even subtle aortic wall disruption and should provide a mechanism for communicating the findings to the surgical team. Noninvasive, cross-sectional imaging techniques have proven efficacy in the diagnosis of aortic pathology and have largely replaced aortography. Both CT and MR imaging provide aortogram-like reconstruction of the original data sets, and in addition to assessing the aortic lumen, permit detailed evaluation of the aortic wall, as well as comprehensive assessment of thoracic and abdominal viscera. This article addresses the role of different imaging modalities in assessment of acute aortic syndromes, with focus on CT and MRI, and with discussion of the key imaging findings that allow distinction among the various aortic pathologies.     

急性主动脉夹层16例临床特点及早期诊断的探讨

目的探讨急性主动脉夹层（AD）患者的易患因素、临床特点及诊断方法,以期提高该疾病的早期诊断水平。方法收集16例急性AD患者的临床资料,对其临床特点、辅助检查资料进行回顾性分析。结果AD患者临床表现多样,胸痛为常见首发症状,高血压是导致AD发生的常见原因。联合应用超声心动图（TTE）、CT和MRI 3种检查方法可以快速明确诊断。结论AD临床表现复杂,掌握其临床特征、保持高度的警惕并及时采取相关的检查是早期发现AD的关键。     

经胸超声心动图诊断升主动脉瘤

目的探讨应用TTE对升主动脉瘤的诊断价值.方法对16例经CT、MRI及手术证实为升主动脉瘤的声像图及CDFI进行了分析,并结合文献总结了其CDFI的诊断与鉴别诊断.结果升主动脉瘤分为真性动脉瘤、假性动脉瘤及夹层动脉瘤三种类型.真性10例,假性1例,夹层主动脉瘤5例.真性主动脉瘤管腔局部扩张,当升主动脉扩张＞50mm时可诊断为动脉瘤.夹层主动脉瘤病变动脉内可见撕裂的动脉内膜.假性动脉瘤是由动脉壁部分破裂,血液溢出血管外形成的包裹性血肿,而非真性动脉扩张.结论TTE可对绝大多数的升主动脉瘤做出明确诊断.可作为随访观察升主动脉扩张及筛检升主动脉瘤的首选方法.     

急诊主动脉夹层的临床和影像学特征分析

【目的】探讨主动脉夹层（AD）的临床特点和各种影像学特征。【方法】收集53例AD患者的临床及各种影像学资料,分析其临床特点和影像学特征。【结果】AD主要病因是高血压（77．3％）,表现为突发胸、背、腰腹撕裂样疼痛等典型症状（48例,90．6％）,血压升高伴休克貌,四肢血压脉搏不对称,部分患者以并发症为首发症状;超声心动图（TTE）、CT血管造影（CTA）、MRI确诊率分别为75％、100％、92．9％。【结论】AD临床表现复杂,CTA是临床急诊诊断AD的首选方法,掌握临床特点早期诊断和合理治疗是改善患者预后的关键。