多排螺旋CT血管造影及数字减影血管造影在B型主动脉夹层中的评估意义

发布时间：2018-05-01 13:01

本文选题：动脉瘤 + 夹层　；参考：《安徽医科大学》2012年硕士论文

【摘要】：目的主动脉夹层（aortic dissectionAD）是主动脉疾病中最常见的重症病。主动脉夹层是由于主动脉内膜破裂，主动脉腔内的血液进入主动脉中膜，并沿主动脉长轴方向延伸剥离，最终导致主动脉真假腔分离、扩展累及主动脉主要分支血管造成血液灌注不良。目前，CT血管造影及数字减影血管造影已广泛应用诊断主动脉夹层，但两者诊断主动脉夹层的一致性尚不明确，本研究的目的是探讨CTA和DSA诊断主动脉夹层的一致性及对主动脉夹层腔内修复术(thoratic endovascularaortic repair TEVAR)的指导意义。方法回顾性分析安徽医科大学附属省立医院2009年6月至2010年12月期间先后行CTA和DSA检查的40例B型急性主动脉夹层患者，其中男性37例，女性3例；年龄36～81岁，平均53.67±9.21岁。多排螺旋CT血管造影有多种技术特点，如多平面重建(MPR)、容积再现技术(VR)、最大密度投影(MIP）、曲面重建(CPR)、表面遮盖显示（SSD）等，成像后可清晰地显示主动脉血管的整体观及形态走向；DSA被视为诊断主动脉夹层动脉瘤的金标准。比较CTA和DSA两种检查方法在显示夹层破口、破口的数目、破口与左锁骨下动脉的距离、左锁骨下动脉平面胸主动脉直径、主动脉夹层累及的范围及主动脉主要分支血管的累及情况、真假腔内血栓形成及钙化状况；34例主动脉夹层行主动脉夹层腔内修复术，行覆膜支架后即刻判断内漏的发生率。结果同期行CTA、DSA检查者40例，两种检查方法在检测主动脉夹层破口数、破口距LSA的距离、胸主动脉直径方面经统计学分析显示无统计学差异。CTA、DSA发现夹层累及左、右侧髂动脉平面的例数分别为16例(16/40,40.0%)、6例(6/40,15.0%)和15例(15/40,37.5%)、6例(6/40,15.0%)，经统计学分析，两种方法在检测夹层累及左、右侧髂动脉平面均有统计学意义(P0.05)。CTA可检测出夹层血栓、动脉壁钙化，而DSA无法显示。40例主动脉夹层患者行主动脉夹层腔内修复术34例，覆膜支架置入后DSA即刻检测发现内漏者11例(11/34,32.35%)。结论CTA、DSA两者对诊断主动脉夹层有较好的一致性，DSA的优势在于术中实时评估病变情况，精确指导覆膜支架的置放。CTA可以对AD的术前各项检测指标作出较可靠的评价并指导拟定手术方案，且其为无创，，可重复性好，可作为术后随访的首选方法。
[Abstract]:Objective Aortic dissection ADA is the most common severe aortic disease. The aortic dissection is caused by the rupture of the aortic intima, the blood in the aortic cavity enters the middle membrane of the aorta and extends along the long axis of the aorta, leading to the separation of the true and false lumen of the aorta. Poor blood perfusion is caused by the expansion of the main branches of the aorta. At present, CT angiography and digital subtraction angiography have been widely used in the diagnosis of aortic dissection. The purpose of this study was to explore the consistency between CTA and DSA in the diagnosis of aortic dissection and its guiding significance in endovascular endovascularaortic repair repair aortic dissection repair. Methods from June 2009 to December 2010, 40 patients with type B acute aortic dissection were examined by CTA and DSA, including 37 males and 3 females, aged 3681 years (mean 53.67 卤9.21 years). Multislice spiral CT angiography has many technical features, such as multiplanar reconstruction, volumetric reconstruction, maximum density projection (MIP), curved surface reconstruction (CPR), surface shaded display (SSDs), etc. DSA is regarded as the golden standard for the diagnosis of aortic dissecting aneurysm. CTA and DSA were compared in showing the dissecting break, the number of breaks, the distance between the break and the left subclavian artery, and the diameter of thoracic aorta in the plane of the left subclavian artery. The extent of aortic dissection and the involvement of the main branches of aorta, the true and false lumen thrombosis and calcification. 34 cases of aortic dissection underwent endovascular repair of aortic dissection, and the incidence of internal leakage was judged immediately after the stenting. Results 40 cases underwent DSA examination at the same time. The two methods were used to detect the number of aortic dissection, the distance from the break to LSA, and the diameter of thoracic aorta showed no statistical difference. The number of cases in the right iliac artery plane were 16 / 40 / 40 / 40.010 / 6 / 6 / 40 / 15.0) and 15 / 15 / 37.5% / 6 / 6 / 4015.0% respectively. By statistical analysis, there were significant differences between the two methods in detecting the left and right iliac artery levels (P0.05). CTA could detect dissecting thrombosis, calcification of artery wall. However, 34 cases of aortic dissection were treated with endovascular repair of aortic dissection, which could not be seen by DSA. 11 cases with internal leakage were detected by DSA immediately after stent-covered stent implantation, and 11 / 34 cases (32.35%) were found to have internal leakage. Conclusion there is a good consistency between CTA-DSA and DSA in the diagnosis of aortic dissection. The advantage of DSA is to evaluate the lesion in real time during operation. The accurate guidance of placement of covered stent. CTA can be used as the first choice for postoperative follow-up because it can be used to evaluate the preoperative parameters of AD and to draw up the operative plan.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2;R543.1

【参考文献】