螺旋CT在主动脉夹层腔内隔绝术治疗中的应用价值

目的 探讨螺旋CT血管成像在主动脉夹层动脉瘤腔内隔绝术后评估中的应用价值。方法 31例StanfordB型夹层动脉瘤腔内隔绝术采用螺旋CT评估，26例单用螺旋CT评估，5例加做MR血管造影（MRA），判断裂口位置、夹层真假腔、夹层范围。结果 螺旋CT显示近端裂口的敏感性为100％，夹层动脉瘤真假腔的识别率为100％；近端裂口位置与术中DSA所见相符合者29例，准确性为93．54％，2例与DSA不符合者，未影响手术方案以及移植物的选择。夹层范围识别的准确性为100％，基于CT结果选择移植物的准确性为100％。结论 CT增强像适合裂口的评判、相关数据的采集。其他多种方式的重建有利于整体解剖形态、夹层范围的观察。模拟内窥镜成像对裂口观察有较大帮助。螺旋CT在腔内隔绝术的术前评估中有重要价值，可作为常规术前检查。

Value of spiral CT in the treatment of aortic dissection with endovascular exclusion

Objective To discuss the value of spiral CT in the preoperative ev aluation of Stanford type B dissections before treated with endovascular exclusi on. Methods Thirty-one cases of consecutive Stanford type B di ssecting thoracic aortic aneurysms were retrospectively studied by reviewing of the multi-recons t uctive Spiral CT images. The image reconstruction methods were dimensional trans verse enhanced scanning, maximum-pixel-intensity projection (MIP), surface ren de red display (SSD), curved planer reformatting (CPR), and Virtual Endoscopic Imag ing (VEI). Results Sensitivity of revealing the tears of the di ssection by Spir al CT was 100%. The ratio of identifying the true and false lumen was 100%. Loca tion of the proximal tears in 29 of the 31 cases displayed on Spiral CT images w ere the same as that of on digital subtracting angiography, which achieved an ac curate ratio of 93.5%. Though the location of the proximal tears i n two of the 31 cases detected by CT scanning did not match to that of DSA, the operation decision or stent-grafts selection were not affected. The detection o f the range of the dissections by CT achieved a ratio of 100%, and the size chose n of the stent-graft based on CT parameters was all correct that in a ratio of 1 00%. Conclusion The spiral CT is of high value in the preoperat ive evaluation o f endovascular exclusion for thoracic aortic dissection. It can act as the routi ne method of choice.