64排螺旋CT在急性主动脉夹层诊断及EVE术后随访中的价值

目的探讨64排螺旋CT在急性主动脉夹层(AAD)诊断及术后随访中的临床价值。方法回顾性分析203例主动脉夹层及行主动脉腔内隔绝术(EVE)治疗36例患者的临床及CT资料,在后处理工作站行多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、容积再现(VR)分析、评价图像,全面观察主动脉夹层CT表现及EVE术后转归情况。结果64排螺旋CT平扫诊断AAD的正确率为14.78%(30/203)。增强扫描中MPR和CPR对破口、真假腔及内膜瓣显示率分别为96.1%、100%,MIP对破口、真假腔及内膜瓣显示率分别为14.3%、65%,VR对破口、真假腔及内膜瓣显示率分别为18.2%、91.1%。MPR和CPR的综合显示能力明显优于VR和MIP(P<0.01)。203例患者中,198例破口为多发、5例破口为单发。33例行EVE术后,破口全部消失,3例远端破口仍然存在,均为破口多发者。36例术后均未见瘤体进一步扩大,17例假腔缩小,9例假腔内见不同程度的血栓形成,3例壁内血肿大部分消失,4例真假腔无明显变化,5例发现内漏。结论怀疑夹层患者CT平扫应关注主动脉表现;64排螺旋CT血管造影对主动脉夹层的诊断及EVE术后随访具有重要的价值,三维重建时应选择MPR、CPR和VR。

The Value of 64 MSCT in Diagnosis and Following-up Observation after Endovascular Exclusion of Acute Aortic Dissection

Objective To discuss clinical value of 64 MSCT in diagnosis and followingup observation after endovascular exclusion(EVE) of acute aortic dissection(AAD). Methods Clinical data and CT images of 203 cases with aortic dissection and 36 cases which received EVE were analyzed retrospectively. multi-planar reconstruction(MPR), curved planar reformation(CPR), maximum intensity projection(MIP) and volume rendering(VR) were performed in post-processing workstation to access and observe CT feature in aortic dissection and postoperative situation. Results The diagnostic accuracy of conventional scan was 14.78%(30/203). The display rates of MPR and CPR in enhanced CT scan on the break, true or false lumen and intimal flap were 96.1% and 100%, respectively. The display rates of MIP on the break, true or false lumen and intimal flap were 14.3% and 65%, respectively. The display rates of VR on the break, true or false lumen and intimal flap were 18.2% and 91.1%, respectively. The overall display capability of MPR and CPR was significantly better than that of VR and MIP(P<0.01) In 203 cases, the break of 198 cases were multiple and 5 cases were singular. The break were disappeared in 33 cases treated by EVE and still exist in 3 cases with multiple break. AAD after EVE did not enlarge in all 36 cases, false lumen shrinked in 17 cases, thrombus in false lumen were found in 9 cases, aortic intramural hematoma mostly disappeared in 3 cases, no variation on true and false lumen size were observed in 4 cases, endoleak were observed in 5 cases. Conclusion Conventional CT aorta signs should be highly valued in the Patients with suspected aortic dissection;64 MSCT angiography has a important value in diagnosis and in following-up observation after EVE on AAD, MPR、CPR and VR should be chosen in the three-dimensional reconstruction.