主动脉夹层的超声与其他影像诊断的比较

本研究对照手术情况分析了15例主动脉夹层患者术前的临床影像诊断结果,旨在对经胸超声心动图(TTE)、经食管超声心动图(TEE),磁共振影像(MRI)、造影剂增强的计算机断层成像(CT)的诊断价值进行比较分析,以进一步指导和服务于临床。资料与方法2000年7月～2004年11月间在我院住院进     

多平面经食管超声心动图与磁共振诊断主动脉夹层的对比 …

目的评价经食管超声心动图与磁共振对主动脉夹层的诊断价值。方法对一组临床上怀疑为主动脉夹层的患者同时进行ＴＥＥ与ＭＲＩ的研究，并将结果与手术及血管造影相对照。结果ＴＥＥ及ＭＲＩ对于主动脉夹层均有较高的准确性和特异性；对于不同亚型的主动脉夹层二者各有所长。结论对于主动脉夹层的诊断，ＴＥＥ及ＭＲＩ均具有十分重要的临床使用价值，交值得的长处结合起来应用，可明显地主动脉夹层的诊断价值。     

超声心动图诊断主动脉夹层的临床应用价值

目的探讨超声心动图诊断主动脉夹层动脉瘤的临床应用价值。方法对采用超声心动图检查诊断的15例主动脉夹层动脉瘤患者与CT、MRCT、DSA等检查方法进行比较,进行总结性分析。结果超声心动图诊断的Standford A型主动脉夹层动脉瘤与计算机断层扫描(CT)、磁共振成像(MRI)、数字减影血管造影(DSA)检查诊断符合率较高。结论超声心动图对诊断Standford A主动脉夹层动脉瘤有重要的临床价值,可作为主动脉夹层的筛查手段。     

急诊经胸超声心动图对主动脉夹层动脉瘤的诊断价值

目的 探讨急诊经胸超声心动图诊断主动脉夹层动脉瘤的临床应用价值。方法 应用HP 5500及Vivid7彩色超声诊断仪，诊断主动脉夹层动脉瘤患者28例，并将其超声检查结果与CT、MRI、DSA、介入及外科手术结果进行比较。结果 主动脉夹层动脉瘤经胸超声心动图与CI、MRI、DSA及手术结果的符合率在98％以上（P〉0．05）。结论 急诊经胸超声心动图诊断主动脉夹层动脉瘤可靠、准确，能清楚鉴别真腔与假腔，显示内膜破口并分型，对指导临床选择最佳治疗方案起着重要意义。     

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     

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     

主动脉窦瘤破裂的经食管超声心动图与手术结果对比分析

目的方法结果结论研究经手术证实主动脉窦瘤破裂（ruptured aortic sinus aneurysm，RASA）的经食管超声心动图（TEE）的诊断价值。方法 对19例经手术证实的主动脉窦瘤破裂与经食管超声心动图进行回顾性对比分析。 结果经食管超声心动图可以准确显示窦瘤的形态、部位、破入方向、血流动力学改变及并发症，与手术结果相符。 结论经食管超声心动图可在手术前及时准确地诊断本病，为外科手术提供更多的信息以指导手术。     

经食管超声心动图在急性Stanford A型主动脉夹层手术中的应用价值

目的探讨经食管超声心动图(TEE)在急性Stanford A型主动脉夹层(AAD)手术中的应用价值。方法选取经全主动脉CTA诊断为ADD的患者41例,术前均行TEE检查,根据TEE检出主动脉根部受累情况分为三组:夹层未累及主动脉根部16例(A组)、主动脉根部轻至中度受累9例(B组)及主动脉根部重度受累16例(C组)。观察各组主动脉根部形态、夹层受累情况(主动脉瓣叶形态、功能)及冠状动脉起始段形态,测量并比较各组主动脉瓣环内径、主动脉窦部内径、窦管交界内径及可显示升主动脉段的最大内径,术后TEE即刻观察手术效果。结果 41例患者术前TEE对升主动脉内撕裂的内膜片显示阳性率为100%。B、C组主动脉窦部内径均大于A组,C组主动脉窦部内径大于B组,差异均有统计学意义(均P0.05);A、B、C组患者主动脉瓣环和升主动脉内径比较差异均无统计学意义。经手术证实,术前TEE诊断夹层累及冠状动脉的特异性为62.5%,敏感性为56.0%。术后TEE成功评估了人工主动脉瓣或修复主动脉瓣形态、功能,以及人工血管、冠状动脉等吻合情况。结论术前TEE能准确评估AAD主动脉根部及冠状动脉受累情况,术后TEE可即刻评估手术效果,具有重要的临床应用价值。     

超声心动图诊断主动脉壁内血肿的应用价值

目的探讨主动脉壁内血肿的超声心动图表现,及经胸和经食管超声心动图在诊断主动脉壁内血肿中的应用价值。方法对经手术或CT证实的13例主动脉壁内血肿的超声心动图进行回顾性分析。其中,累及升主动脉(A型)6例,仅降主动脉受累(B型)7例。结果主动脉壁内血肿的临床症状与经典的主动脉夹层分离相似,均表现为剧烈的胸背痛或腹痛。9例(69.23%)患者有明确的高血压病史。其超声心动图表现为局部或弥漫的主动脉管壁增厚,呈新月状或环状,无内膜片撕裂,无破口及假腔形成,彩色多普勒超声心动图上无真假腔之间的交通血流。A型主动脉壁内血肿可伴有明显主动脉瓣反流、胸腔积液、心包积液,甚至出现心包填塞。结论超声心动图,尤其经食管超声心动图是诊断主动脉壁内血肿的有效手段,对主动脉壁内血肿的临床治疗具有重要的指导意义。     

经胸和经食管超声心动图诊断主动脉左室通道

主动脉左室通道(aorto-left ventricular tunnel)是主动脉与左心室之间存在的经主动脉瓣膜旁侧的异常交通，是一种十分罕见的先天性心脏畸形。国外于1961年首次报告本病，国内外只有零星的病例报道。经胸超声心动图(TTE)在本病的诊断中发挥重要的作用，但国内外文献中经食管超声心动图(TEE)的检查报道病例很少。本文根据我们的临床资料，总结TTE和TEE在主动脉左室通道中的诊断价值。     

Diagnosis of aortic dissection by transesophageal echocardiography during cardiopulmonary resuscitation

ObjectivesEarly identification of the causes of cardiac arrest is helpful in determining the resuscitation measures during cardiopulmonary resuscitation (CPR). We aimed to evaluate the feasibility of transesophageal echocardiography (TEE) during CPR in diagnosing aortic dissection and the influence of aortic dissection on resuscitation outcome in adult patients with prolonged non-traumatic cardiac arrest.MethodsAdult patients aged >20 years with non-traumatic cardiac arrest who underwent prolonged CPR (>10 min) and TEE examination during CPR were enrolled. The enrolled patients were grouped according to the presence of aortic dissection on TEE: the aortic dissection (AD) group and the non-AD group. Variables related to cardiac arrest event, CPR, and resuscitation outcome were compared between the two groups.ResultsForty-five patients (median age, 71 years; 26 men) were enrolled. Ten (22.2%) and 35 (77.8%) patients were included in the AD and non-AD groups, respectively. No patients in the AD group survived. Aortic dissection on TEE was inversely related to the rate of return of spontaneous circulation on multivariate analysis (odds ratio, 0.019; 95% confidence interval, 0.001–0.750; p = .035).ConclusionTEE is a useful tool for diagnosing aortic dissection as a cause of cardiac arrest during CPR. Aortic dissection is associated with poor resuscitation outcomes.     

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.     

Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms

Purpose: To verify the diagnostic potentialities of conventional magnetic resonance imaging (MRI), breath-hold 3D contrast enhanced MR angiography (C3D MRA) and transesophageal echocardiography (TEE) in patients surgically treated for type A aortic dissection. Materials and methods: Twenty-nine patients (21 males and 8 females), surgically treated for type A aortic dissection, were evaluated with MRI using a 1.5 T (GE Horizon Echospeed 8.2) with standard gated SE sequences and breath-hold 3D fast SPGR after intravenous Gd injection (0.2 mmol/kg). 3D MIP reconstruction was obtained. TEE evaluation was performed with a HP 2000 system and a biplane 5 MHz probe. The sizes of aortic root, distal anastomosis, descending aorta and periprosthetic thickening were measured. Regional false lumen and aortic branch involvement were also evaluated. Results: Concordance among TEE, conventional MRI and C3D MRA was observed in the evaluation of aortic root (MRI vs. C3D MRA r = 0.93; MRI vs. TEE r = 0.84; C3D MRA vs. TEE r = 0.84) and descending aorta (r = 0.94, 0.91 and 0.92, respectively). The interobserver variability was also very low. Inadequate agreement was observed for distal anastomosis. C3D MRA was inadequate in the evaluation of periprosthetic thickening; r = 0.73 was obtained between MRI and TEE. For qualitative data: TEE was inadequate in the evaluation of the abdominal aorta and branches. C3D MRA depicted supra-aortic vessel involvement in more cases than the other techniques. Conclusion: C3D MRA is a fast and accurate technique in the evaluation of the endoluminal alterations and involvement of the aortic branches. Conventional MRI allows a direct evaluation of the aortic wall and periaortic tissue. TEE is less accurate in the evaluation of aortic branches and abdominal aorta.     

Diagnosis of aortic transection by transesophageal echocardiography.

Transesophageal echocardiography (TEE) offers spectacularly detailed images of thoracic aortic anatomy and blood flow; however, its utility for diagnosis of aortic trauma is unknown. Our case underscores the ability of TEE to diagnose aortic transection. The speed, mobility, and accuracy of TEE makes it an attractive means of diagnosing aortic trauma in the critically ill.     

Ambulatory follow-up of aortic dissection: comparison between computed tomography and biplane transesophageal echocardiography

Aim of the study was to assess the relative usefulness of transesophageal echocardiography (TEE) and X-ray computed tomography (CT) in the follow-up of patients who survived an aortic dissection. Materials and Methods. We evaluated 44 patients (age = 57±12 years) with treated aortic dissection: 14 had a De Bakey type I, 20 a type II and 1 patient a type III dissection treated surgically; 1 patient had a type I, 1 a type II and 7 a type III dissection treated medically. All entered an outpatient follow-up program with serial evaluations at 1, 6 and 12 months after initial diagnosis by dual noninvasive imaging protocol. A contrast-enhanced CT scan and a TEE with biplane probe were performed on the same day and in random order. Results. A total of 252 evaluations with both CT and TEE were considered. A completely normal study was found in 45 TEE and 48 CT evaluations. The following abnormal findings could be documented by one or both techniques: thrombus in the false lumen (TEE: n=48; CT: n=45 evaluations); intimal flap (TEE and CT: n=68); aortic dilatation (TEE and CT: n=15); pericardial effusion (TEE and CT: n=3); aortic pseudoaneurysm (TEE: n=2; CT: n=3); isthmic coarctation (TEE and CT: n=1). Regarding the presence or absence of these abnormalities, which are within the diagnostic domain of both imaging techniques, the results were fully concordant in 245 studies, and discordant in 7, with an overall agreement of 97%. In addition, some abnormal findings could be detected by TEE only: aortic insufficiency (n=36); intimal tear (n=25); spontaneous echocontrast effect in the false lumen (n=39 evaluations). Other abnormal findings could be detected by CT only: a pleural effusion in 4, a truncus anonymous dissection in 1, a pseudoaneurysm due to suture dehiscence of the distal anastomosis of the ascending aorta in 1 evaluation (which yielded ambiguous results by TEE, with turbulent flow departing from the graft). Conclusion. Both CT and TEE are atraumatic, safe and accurate techniques for serial follow-up imaging of patients treated for aortic dissection. Information provided by CT is largely redundant, rather than additive, to that provided by TEE. The latter should be probably preferred for shorter imaging time, accuracy and convenience, although CT might still play a role in selected cases of ambiguous TEE results.     

MRI对主动脉夹层的诊断与临床指导价值

目的探讨MRI对主动脉夹层的诊断与临床指导价值。方法对11例主动脉夹层患者的MRI资料进行回顾性分析。结果按照Stanford分型:A型7例,B型4例;按照De Bakey分型:I型6例,Ⅲ a型4例,Ⅲb型1例。11 例均可见主动脉内膜片及其被分隔的真假腔,共累及9条分支大血管。结论 MRI能够对主动脉夹层作出快速、安全的诊断,并为临床治疗提供详尽、可靠的信息,是主动脉夹层的首选无创性检查方法。     

主动脉病变的非增强MRI检查

目的以造影剂增强MRA（CE-MRA）为参照,评价非增强MRI检查方式在诊断主动脉病变的意义。方法17例主动脉病变患者,非增强MRI检查采用亮血对比的FIESTA电影序列和黑血对比的双反转或者三反转FSE序列,CE-MRA采用Gd-DTPA增强三维TOF序列,比较两种检查方式对病变的诊断和解剖细节的显示效果。结果主动脉夹层7例,动脉瘤7例,降主动脉岬部缩窄2例,非增强MRI和CE-MRA诊断一致;主动脉弓粥样硬化穿通性溃疡1例只能由非增强MRI做出诊断;CE-MRA能显示病变的整体观,而非增强MRI在显示血栓形成和血流动态方面比CE-MRA有优势。结论非增强MRI对主动脉病变的诊断具有与CE-MRA同样重要的作用,两者显示的信息可以互相补充,建议纳入MRA的常规内容。     

主动脉夹层的影像诊断

目的探讨主动脉夹层的ＣＴ、ＭＲＩ影像表现。方法对９例主动脉夹层的ＣＴ与ＭＲＩ所见,以及两种检查技术进行对比分析。结果ＣＴ漏诊１例,ＣＴ和ＭＲＩ诊断率分别为８８％和１００％。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。二者对内膜片及双腔显示率相似。结论ＣＴ和ＭＲＩ均是诊断夹层首选方法。