CT断层图像和三维重建在主动脉腔内隔绝术术前评估中的价值

目的比较CT断层图像和三维重建在主动脉腔内隔绝术术前评估中的价值。方法将接受主动脉腔内隔绝术的20例主动脉夹层瘤和12例腹主动脉瘤患者作为研究对象,术前分别在CT断层图像与三维重建图像上测量的各相关参数,与主动脉造影所测量的相同参数进行对照分析。结果CT断层图像上所测量的主动脉弓直径及各种长度指标均小于主动脉造影结果;夹层瘤近段主动脉直径及近端瘤颈直径、主动脉中段直径以及左右髂动脉直径均大于主动脉造影结果;三维重建所测量的上述各项参数与主动脉造影结果非常接近,并能清楚显示夹层分离的破裂口,而断层图像上不易发现破裂口;断层图像和三维重建在显示主动脉附壁血栓和测量最大瘤体直径方面优于主动脉造影。以三维重建测量为标准选择覆膜支架,所有患者均成功封闭瘤体。结论主动脉腔内隔绝术术前评估时应结合CT断层图像和三维重建图像综合分析,覆膜支架的选择应以三维重建测量结果为主。

Values of computed tomographic axial images and three - dimensional reconstructed images in evaluation of aortic dissection and aortic aneurysm before endovascular aortic repair

Objective To compare the accuracy of measurements between computed tomographic(CT) axial images and three-dimensional reconstructed images(3D) in evaluation of aortic dissection of aortic aneurysm before endovascular aortic repair.Methods Aortic axial images were got from thin-slices scanning in 20 patients with aortic dissection and 12 patients with abdominal aortic aneurysm.Multi-planar reconstruction and maximal intensity projection were used for 3D images.Parameters related to aortic dissection and aneurysm were measured from CT axial and 3D images and compared with those from aortography. Results Diameters of arch,lengths of neck and aneurysm were smaller measured on CT axial images than those by 3D and aortographic images.The proximal aortic diameters of dissection or aneurysm,middle aortic diameter and diameters of bilateral iliac arteries were greater measured by CT axial images than by those of 3D images and aortography.There were no remarkable differences between the measurements from 3D images and aortographies.The breakage of dissection can be easily demonstrated by 3D images and aortographies but not by CT axial images.However,CT axial and 3D images revealed more accuracy than aortographice in detecting thrombi and measuring the maximal diameters of aneurysm.Endovascular grafts were chosen according to measurements by CT 3D images and outcoming with successful closure of all the dissections and aneurysms.Conclusions Combined CT axial and 3D images can provide accurate evaluation of aortic dissection and aneurysm before endovascular aortic repair,especialy CT 3D images was strongly recommended to determine size of endovascular grafts.