螺旋CT血管成像及三维重建在主动脉病变诊断中的临床应用

目的评价螺旋ＣＴ血管成像（ＳＣＴＡ）及三维重建在主动脉疾病诊断中的临床应用价值，并比较ＳＣＴＡ各种成像方法的诊断价值。方法对３５例患者进行了ＳＣＴＡ成像，１７例与手术对照，其中４例又与血管造影对照。结果⑴ＳＣＴＡ良好地显示了主动脉瘤、主动脉夹层（２３例）和主动脉弓异常（８例）。１７例与手术对照，ＳＣＴＡ诊断符合率９４％。⑵对解剖关系复杂的主动脉弓分叉区域病变的显示及表面阴影显示（ＳＳＤ）较理想。⑶在主动脉瘤及主动脉夹层中，横断面影像准确、可靠，而三维及多平面重建（ＭＰＲ）在空间关系的显示上具有优势。结论ＳＣＴＡ二维和三维重建影像的联合应用可以较明确地诊断多种主动脉疾病，可帮助和指导手术，可望取代常规血管造影对主动脉病变的诊断。

Clinical application of spiral CT angiography and three dimensional reconstruction in the diagnosis of aortic diseases

Purpose To evaluate the clinical application of spiral CT angiography (SCTA) and three dimensional (3D) reconstruction in the diagnosis of aortic diseases, and to compare the diagnostic value of several SCTA imaging techniques. Methods 35 cases underwent SCTA and 17 cases were confirmed by operation or conventional angiography. Results (1) SCTA images could clearly show the lesions of aneurysm or aortic dissection( 23 cases) and the complicated anatomic relationship and malformations in aortic arch area(8 cases). 17 cases received operation and the SCTA diagnosis coincided well with the operative findings in 94% of cases. (2) SSD was the optimal imaging method for malformation in aortic arch area where the anatomic relationship was confusing. (3) For aneurysm and aortic dissection, axial image was most accurate, but SSD,MIP,MPR were better in showing the space relationship of targic vascular lesions with its main branches. Conclusion With combined application of two and three dimensional reconstruction, SCTA is helpful in correct diagnosis and guiding surgery and may replace conventional angiography in aortic diseases in future.