双源CT血管造影综合评估Stanford A型主动脉夹层

摘要

目的 评价双源CT血管造影(DSCTA)综合评价Stanford A型主动脉夹层(AD)主动脉根部结构、冠状动脉和左心室功能的可行性.方法 对36例Stanford A型AD患者行术前心电门控DSCTA扫描,评价冠状动脉、主动脉及主动脉瓣膜图像质量及受累情况,测量主动脉根部管径和左心室功能,计算辐射剂量.将DSCTA结果与手术所见进行比较.结果 35例患者成功完成DSCTA检查.97.14％(34/35)的胸主动脉和主动脉瓣膜图像、93.10％(445/478)的冠状动脉节段图像可用于诊断.右窦受累17例,无窦受累15例,左窦受累5例；右无窦交界受累13例,左右窦交界受累3例,左-无窦交界受累1例.主动脉窦部直径(41.6±9.4)mm;瓣环直径(28.2±4.1)mm；窦管交界直径(73.6±10.2)mm.左心室射血分数与主动脉根部受累程度呈负相关(r=-0.97,P=0.02).平均有效辐射剂量为(21 96±4.36)mSv.DSCTA结果与手术病理诊断一致率(30/34,88.24％)和一致性(Kappa=0.82,P＜0.01)均较高.结论 DSCTA“一站式”检查综合评价Stanford A型AD主动脉根部结构、冠状动脉和左心功能安全可靠.%Objective To investigate the feasibility of comprehensive assessment for Stanford type A aortic dissection (AD) including survey of aortic root structure, coronary artery and function of left ventricular using dual source computed tomography angiography (DSCTA). Methods Thirty-six patients with Stanford type A AD underwent retrospective ECG-gating CT angiography using DSCT. The imaging quality and abnormalities of coronary artery, aorta and aortic valve were evaluated. The diameter of aortic root, function of left ventricular and radiation dose were evaluated and compared with surgical results. Results Thirty-five patients completed the examination. Acceptable image quality was achieved in 97. 14% (34/35) for aorta and aortic valve, 93. 10% (445/478) coronary arterial segments. Right valsalva sinus was involved in 17, non-coronary valsalva sinus in 15, left valsalva sinus in 5, the joint area of right-non sinus in 13, left-right sinus in 3 and left-none sinus in 1 patient. The average diameter of valsalva sinuses, aortic annulus, and proximal aorta was (41. 6±9. 4)mm, (28. 2±4. Dmm and (73. 6±10. 2)mm, respectively. The left ventricular ejection fraction negatively related to the degree of arotic valve insufficiency (r=-0. 97, P=0. 02). The average effective radiation dose was (21. 96± 4. 36)mSv. The diagnosis agreement between classification diagnosis of MSCTA and pathology was 88. 24% (30/34), and the consistency was excellent (Kappa = 0. 82, P<0. 01). Conclusion One stop shop MSCTA can provide comprehensive assessment for Stanford type A AD, including survey of aortic root structure, coronary artery and function of left ventricular.