【作者】 陈亮；

【导师】 易定华； 刘金成； 杨剑；

【作者基本信息】 第四军医大学 ， 外科学， 2009， 硕士

【摘要】 及时、准确的诊断胸主动脉夹层动脉瘤(thoracic aortic dissection,TAD)并采取相应的手术或介入治疗,对于降低患者的病死率是极为必要的;而TAD破口位置、大小的准确诊断对确定手术方式又是非常重要的。目前,除有创检查的主动脉造影术外,影像学检查还有经胸壁超声(transthoracic echocardiography , TTE)、多层螺旋CT(multi-slice spiral computed tomography,MSCT)和磁共振(magnetic resonance imaging,MRI),在诊断TAD和其破口方面各有优缺点,准确度不一。如新一代的CT技术——双源CT(dual-source computed tomography,DSCT)有着比以往CT更多的优势:时空分辨率更高,运动伪影干扰更少,扫描更快,检查时间更短,其冠状动脉成像好,可以很好的评估冠状动脉疾病。本研究旨在对比研究DSCT对TAD及其破口位置、大小的诊断准确度,明确其在诊断TAD方面的临床应用价值。方法:选取2008年1 ~ 10月间初诊疑似TAD的连续139例患者,DSCT检查结果与其他影像学检查对照,包括数字减影血管造影术(digital subtraction angiography,DSA)、TTE、64层MSCT和MRI。结果:TAD确诊97例。DSCT、DSA、TTE、MSCT和MRI分别检查112、72、94、60和6例,诊断TAD的灵敏度分别为100%、100%、95%(P < 0.05)、93%(P < 0.05)和100%,与DSCT比较,差异有统计学意义。DSCT、DSA、TTE和MSCT诊断TAD破口的灵敏度分别为98%、98%、46%(P < 0.05)和87%(P < 0.05),DSCT与TTE和MSCT相比较,差异有统计学意义。结论:DSCT术前诊断TAD破口准确性高,宜作为首选的影像学检查方法。更多还原

【Abstract】 Early and accurate diagnosis and decision making regarding surgical or conservative intervention are essential to reduce morbidity and mortality among patients with clinically thoracic aortic dissection(TAD), expecially confirming the tears of TAD. Imaging techniques including transthoracic echocardiography(TTE), multi-slice spiral computed tomography(MSCT), magnetic resonance imaging(MRI) and invasive digital subtraction angiography(DSA); However, capabilities of the 4 imaging techniques were found to be differences for confirming or excluding the tears of TAD. The next generation of imaging technology, dual-source CT(DSCT), offers many advantages over conventional CT: temporal resolution is improved; motion artifacts are minimal; scanning is more rapid; examination time is substantially shorter. DSCT cardiac imaging have shown a robust image quality and a very good diagnostic accuracy of coronary CT angiography. Then patients with TAD were examined by DSCT in this controlled trial to assess the clinical application value of DSCT.Methods: From January to October of 2008, 139 consecutive patients with suspected TAD were enrolled in this trial by comparing DSCT with other imaging modalities including DSA, TTE, 64-MSCT and MRI.Results: Ninety-seven patients were diagnosed TAD. The samples of DSCT, DSA, TTE, MSCT and MRI were 112, 72, 94, 60 and 6, respectively. The diagnosis sensitivity were 95% for TTE(P<0.05), 93% for MSCT(P<0.05), 100% for DSCT, DSA and MRI. The diagnostic accuracy for preoperative revealing of the tears of TAD of DSCT, DSA, TTE and MSCT were 98%, 98%, 46% (P<0.05) and 87%(P<0.05). Compare with DSCT, these differences had significances.Conclusion: The diagnostic accuracy of DSCT for preoperative revealing of the tears of TAD is higher than DSA, TTE, MSCT or MRI. This is good as the primary checking option of imaging modalities.更多还原