MDCT在胸痛中心主动脉夹层筛查中的临床价值
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摘要
目的探讨胸痛中心应用MDCT平扫,在筛查主动脉夹层(AD)患者中的临床价值。方法收集本院胸痛中心筹建以来MDCT平扫疑诊AD,并有完整MDCT及CTA资料患者共计78例,记录6个与AD相关MDCT征象的阳性率,计算MDCT筛查AD的灵敏度,并比较Stanford A、B型AD在各MDCT征象阳性率的差异,分析致死AD患者MDCT影像学特征。结果 72例MDCT阳性患者经CTA确诊为AD,Stanford A、B型AD分别有26、46例。6例MDCT平扫为假阳性结果,MDCT筛查AD的灵敏度为92.3%;在MDCT筛查中AD直接征象和间接征象阳性率分别为97.2%和88.9%。主动脉腔内异常密度影及心包积液阳性率在A型AD中高于B型AD(P<0.05)。钙斑内移征象阳性率随年龄增大增多(P=0.017)。A、B型AD入院72h内死亡率为23.1%、17.4%,MDCT直接及间接征象在致死AD阳性率均为100%,心包积液、主动脉增粗是AD导致死亡的危险因素(P<0.05)。结论 MDCT对AD的筛查具有较高的敏感度,可作为胸痛中心首选的检查方法,A、B型AD及致死AD在MDCT影像学征象各有特点。
Objective To explore the clinical value of emergency MDCT scan in screening aortic dissection(AD) in the chest pain center. Methods A total of 78 patients with suspected aortic dissection in MDCT were collected since the establishment of the hospital chest pain center, and all of 78 patients underwent MDCT and CTA. The positive rates of these 6 MDCT findings related to AD were calculated. The sensitivity of MDCT in screening AD was calculated. The positive rate of MDCT signs between Stanford A and B AD was compared by statistical analysis. The imaging features of MDCT in patients with fatal AD were analyzed. Results 72 patients were diagnosed as AD according to CTA, 26 cases were type A and 46 cases were type B. 6 cases of MDCT were false-positive. MDCT sensitivity was 92.3 %. The positive rates of direct and indirect signs of AD in MDCT screening were 97.2% and 88.9%, respectively. The positive rate of abnormal density and pericardial effusion in type A AD was higher than that in type B AD(P<0.05). The positive rate of calcium plaque migration increased by age increase(P=0.017). Within 72 hours of admission, the death rate of type A and B AD was 23. 1% and 17. 4%, respectively. The positive rate of direct and indirect MDCT signs in lethal AD both was 100%. Pericardial effusion and aortic thickening were risk factors for death of AD(P<0.05). Conclusion MDCT has high sensitivity in screening of AD, so it can be used as the first choice for the examination of chest pain center. Type A, B AD and higher mortality risk AD have different characteristics in MDCT imaging.
Objective To explore the clinical value of emergency MDCT scan in screening aortic dissection(AD) in the chest pain center. Methods A total of 78 patients with suspected aortic dissection in MDCT were collected since the establishment of the hospital chest pain center, and all of 78 patients underwent MDCT and CTA. The positive rates of these 6 MDCT findings related to AD were calculated. The sensitivity of MDCT in screening AD was calculated. The positive rate of MDCT signs between Stanford A and B AD was compared by statistical analysis. The imaging features of MDCT in patients with fatal AD were analyzed. Results 72 patients were diagnosed as AD according to CTA, 26 cases were type A and 46 cases were type B. 6 cases of MDCT were false-positive. MDCT sensitivity was 92.3 %. The positive rates of direct and indirect signs of AD in MDCT screening were 97.2% and 88.9%, respectively. The positive rate of abnormal density and pericardial effusion in type A AD was higher than that in type B AD(P<0.05). The positive rate of calcium plaque migration increased by age increase(P=0.017). Within 72 hours of admission, the death rate of type A and B AD was 23. 1% and 17. 4%, respectively. The positive rate of direct and indirect MDCT signs in lethal AD both was 100%. Pericardial effusion and aortic thickening were risk factors for death of AD(P<0.05). Conclusion MDCT has high sensitivity in screening of AD, so it can be used as the first choice for the examination of chest pain center. Type A, B AD and higher mortality risk AD have different characteristics in MDCT imaging.
引文
[1] 薛军,韩占红,王明晓,等.北京市急诊胸痛的病因学调查分析[J].中国综合临床,2012,28(10):1042-1046.
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[5] 梁煜坤,张晓丽,汪峥,等.CT平扫对于主动脉夹层动脉瘤的诊断方法学研究[J].中国CT和MRI杂志,2016,14(2):56-59.
[6] Chiu KW,Lakshminarayan R,Ettles DF.Acute aortic syndrome:CT findings[J].Clin Radiol,2013,68(7):741-748.
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[9] 张志,徐妍妍,闫圣涛,等.平扫CT在急诊疑似主动脉夹层患者中的诊断价值[J].中日友好医院学报,2017,31(4):203-206.
[10] Pape LA,Awais M,Woznicki EM,et al.Presentation,diagnosis,and outcomes of acute aortic dissection:17-Year trends from the international registry of acute aortic dissection [J].J Am Coll Cardiol,2015,66(4):350-358.
[11] Hallinan JT,Anil G.Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes [J].World J Radiol,2014,6(6):355-365.
[12] Baliga RR,Nienaber CA,Bossone E,et al.The role of imaging in aortic dissection and related syndromes [J].JACC Cardiovasc Imaging,2014,7(4):406-424.
[13] 原小军,郝粉娥,赵磊,等.主动脉夹层撕裂内膜走行规律的MSCTA研究[J].中国医学影像技术,2017,33(1):35-39.
[14] 盛军,陈宏山.多层螺旋CT血管成像及后处理技术在主动脉夹层患者中的应用效果[J].安徽医学,2018,39(5):568-571.
[15] 李金燕,王锡明,段艳华,等.CT平扫在疑似主动脉夹层中的诊断价值[J].医学影像学杂志,2015,25(1):60-64.
[16] Chou AS,Ziganshin BA,Elefteriades JA.Computed tomography imaging artifact simulating Type A aortic dissection [J].Aorta (Stamford),2016,4(2):72-73.
[17] Husainy MA,Sayyed F,Puppala S.Acute aortic syndrome-pitfalls on gated and non-gated CT scan [J].Emerg Radiol,2016,23(4):397-403.
[18] Yamaguchi S,Murakami H,Kudo T,et al.Usefulness of the echocardiographic paravertebral approach for the diagnosis of descending thoracic aortic dissection [J].J Echocardiogr,2017,15(3):127-134.
[2] Erbel R,Aboyans V,Boileau C,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases:document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (ESC)[J].Eur Heart J,2014,35(41):2873-2926.
[3] 张芝,刘涛,付建立,等.256层螺旋CT三联检查在急性胸痛诊断中的临床应用价值[J].医学影像学杂志,2017,27(5):829-833.
[4] Melvinsdottir IH,Lund SH,Agnarsson BA,et al.The incidence and mortality of acute thoracic aortic dissection:results from a whole nation study [J].Eur J Cardiothorac Surg,2016,50(6):1111-1117.
[5] 梁煜坤,张晓丽,汪峥,等.CT平扫对于主动脉夹层动脉瘤的诊断方法学研究[J].中国CT和MRI杂志,2016,14(2):56-59.
[6] Chiu KW,Lakshminarayan R,Ettles DF.Acute aortic syndrome:CT findings[J].Clin Radiol,2013,68(7):741-748.
[7] Maddu KK,Shuaib W,Telleria J,et al.Nontraumatic acute aortic emergencies:Part 1,Acute aortic syndrome [J].AJR,2014,202(3):656-665.
[8] 王建,刘何鹏.多层螺旋CT诊断主动脉夹层临床分析[J].医学影像学杂志,2018,28(6):929-932.
[9] 张志,徐妍妍,闫圣涛,等.平扫CT在急诊疑似主动脉夹层患者中的诊断价值[J].中日友好医院学报,2017,31(4):203-206.
[10] Pape LA,Awais M,Woznicki EM,et al.Presentation,diagnosis,and outcomes of acute aortic dissection:17-Year trends from the international registry of acute aortic dissection [J].J Am Coll Cardiol,2015,66(4):350-358.
[11] Hallinan JT,Anil G.Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes [J].World J Radiol,2014,6(6):355-365.
[12] Baliga RR,Nienaber CA,Bossone E,et al.The role of imaging in aortic dissection and related syndromes [J].JACC Cardiovasc Imaging,2014,7(4):406-424.
[13] 原小军,郝粉娥,赵磊,等.主动脉夹层撕裂内膜走行规律的MSCTA研究[J].中国医学影像技术,2017,33(1):35-39.
[14] 盛军,陈宏山.多层螺旋CT血管成像及后处理技术在主动脉夹层患者中的应用效果[J].安徽医学,2018,39(5):568-571.
[15] 李金燕,王锡明,段艳华,等.CT平扫在疑似主动脉夹层中的诊断价值[J].医学影像学杂志,2015,25(1):60-64.
[16] Chou AS,Ziganshin BA,Elefteriades JA.Computed tomography imaging artifact simulating Type A aortic dissection [J].Aorta (Stamford),2016,4(2):72-73.
[17] Husainy MA,Sayyed F,Puppala S.Acute aortic syndrome-pitfalls on gated and non-gated CT scan [J].Emerg Radiol,2016,23(4):397-403.
[18] Yamaguchi S,Murakami H,Kudo T,et al.Usefulness of the echocardiographic paravertebral approach for the diagnosis of descending thoracic aortic dissection [J].J Echocardiogr,2017,15(3):127-134.