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。
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.
引文
[1] Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease[J]. JAMA, 2000,283:897-903.
[2] Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection[J]. Eur Heart J, 2001,22:1642-1681.
[3] Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection[J]. Circulation, 2006, 114:2226-2231.
[4] Robicsek F, Thubrikar MJ. Hemodynamic considerations regarding the mechanism and prevention of aortic dissection[J]. Ann Thorac Surg, 1994, 58:1247-1253.
[5] Luo JF, Liu Y, Huang WH, et al. Endovascular repair for patients with DeBakey III aortic dissection[J]. Zhonghua Xin Xue Guan Bing Za Zhi, 2008,36(2):132-136.
[6] Hüseyin I, Christoph AN. Management of acute aortic syndromes[J]. Rev Esp Cardiol, 2007,60:526-541.
[7] Fuster V, Halperin JL. Aortic dissection: a medical perspective[J]. Card Surg, 1994, 9(6):713-728.
[8] Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection[J]. Chest, 2002,122(1):311-328.
[9]张建,景在平.主动脉夹层病因学分析[J].外科理论与实践, 2007, 12(1):84-86.
[10] Tanchev S, Tanchev L. Marfan syndrome and aortic dissection during pregnancy[J]. Akush Ginekol, 2008,47(4):47-49.
[11] Patel PD, Arora RR. Pathophysiology, diagnosis, and management of aortic dissection[J]. Ther Adv Cardiovasc Dis, 2008,2(6):439-468.
[12] Loeys B, De Paepe A. New insights in the pathogenesis of aortic aneurysms. [J] Verh K Acad Geneeskd Belg, 2008,70(2):69-84.
[13] Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection[J]. Chest, 2000,117(5):1271-1278.
[14] Bernard Y, Zimmermann H,Chocron S,et al. False lumen patency as a predictor of late outcome in aortic dissection[J]. Am J Cardiol. 2001, 87(12):1378-1382.
[15] Sawhney NS, DeMaria AN, Blanchard DG. Aortic intramural hematoma: an increasingly recognized and potentially fatal entity[J]. Chest, 2001, 120(4):1340-1346.
[16] Kodolitsch Y, Nienaber CA. Ulcer of the thoracic aorta: diagnosis, therapy and prognosis[J]. Z Kardiol, 1998,87(12):917-927.
[17] Harris JA, Bis KG, Glover JL, et al. Penetrating atherosclerotic ulcers of the aorta[J]. Vasc Surg, 1994,19:90-98.
[18] Cooke JP, Kazmier FJ, Orszulak TA. The penetrating aortic ulcer: pathologic manifestations, diagnosis, and management[J]. Mayo Clin Proc, 1988, 63:718-725.
[19]黄连军,俞飞成.主动脉夹层的影响学诊断与介入治疗[J].介入放射学杂志, 2005,(14):25-30.
[20] Bilku RS, Steadman CD, Jordan PJ. Acute DeBakey Type III (or Stanford Type B) aortic dissection diagnosed by transthoracic echocardiography[J]. Am Soc Echocardiogr, 2008,21(9):1080-1084.
[21]韩玉平,张晓蓉,孔金金,等.彩色多普勒超声对动脉瘤诊断的进一步研究[J].中国超声诊断杂志, 2005,6(8):592-595.
[22] Flohr Th, Stierstorfer K, Bruder H, et al. Image reconstruction and image quality evaluation for a 16-slice CT scanning[J]. Med Phys, 2003,30(5): 832-845.
[23] Hayashi H, Kumazaki T. Multidetector-row CT evaluation of aortic disease[J]. Radiat Med, 2005,23(1):1-9.
[24] Ledbetter S, Stuk JL, Kaufman JA. Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes: traumatic aortic rupture, aortic aneurysm, aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer[J]. Radiol Clin North Am, 1999,37:575-589.
[25] Williams DM, Joshi A, Dake MD, et al. Aortic cobwebs:an anatomic marker identiyfing the false lumen in aortic dissection-imaging and pathologic correlation[J]. Radiology, 1994,190(1):167-174.
[26] Smith AD, Schoenhagen P. CT imaging for acute aortic syndrome[J]. Cleve Clin J Med, 2008,75(1):7-9.
[27] Harris KM, Brvaerman AC, Gutierrez FR, et al. Transesophageal echocardiographic and clinical features of aortic intramural hematoma[J]. Thorac Cardiovasc Surg, 1997,114(4):619-626.
[28] Castaner E, Andreu M, Gallardo X, et al. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications[J]. Radiographics, 2003,23:S93–110.
[29] Quint LE, Williams DM, Francis IR, et al. Ulcer-like lesions of the aorta: imaging features and natural history[J]. Radiology, 2001,218:719–723.
[30] Tomiguchi S, Morishita S, Nakashima R, et al. Usefulness of turbo FLASH dynamic MR imaging of dissecting aneurysms of the thoracic aorta[J]. Cardiovasc Intervent Radiol, 1994,17:17-21.
[31] Sommer T, Fehske W, Holzknecht N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography and MR imaging[J]. Radiology, 1996, 199:347-352.
[32] Kodolitsch Y, Krause N, Spielmann R, et al. Diagnostic potential of combined transthoracic echocardiography and X-ray computed tomography in suspected aortic dissection[J]. Clin Cardiol, 1999,22:345 -352.
[33] Golledge J, Eagle KA. Acute aortic dissection[J]. Lancet, 2008,372 (9632): 55-66.
[34] Safi HJ, Taylor PR. Open surgery for thoracic aortic disease[J]. Heart, 2003,89:825-826.
[35] Sarasin FP, Louis-Simonet M, Gaspoz JM,et al. Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optimal diagnostic test[J]. Ann Emerg Med, 1996,28(3):278-288.
[36] Narayan P, Rogers CA, Davies I, et al.Type A aortic dissection: has surgical outcome improved with time[J]? Thorac Cardiovasc Surg, 2008, 136(5):1172-1177.
[37] Umana JP, Miller DC, Mitchell RS. What is the best treatment for patients with acute type B aortic dissections-Medical, surgical, or endovascular stent-grafting[J]? Ann Thorac Surg, 2002,74:S1840-1843.
[38] Benedetto F, La Spada M, Stilo F, et al. Endovascular repair in atypical traumatic rupture of thoracic aorta[J]. G Chir, 2008,29(10):429-431.
[39] Pearce BJ, Passman MA, Patterson MA, et al. Early outcomes of thoracic endovascular stent-graft repair for acute complicated type B dissection using the Gore TAG endoprosthesis[J]. Ann Vasc Surg, 2008,22(6):742- 749.
[40] Parker JD, Golledge J. Outcome of endovascular treatment of acute type B aortic dissection[J]. Ann Thorac Surg, 2008, 86(5):1707-1712.
[41] Jing QM, Han YL, Wang XZ, et al. Percutaneous transluminal stenting in patients with acute and chronic aortic dissections[J]. Zhonghua Nei Ke Za Zhi, 2008,47(4):281-283.
[42]刘维永,左键.腔内支架置入术治疗胸部大血管病的进展[J].中国微创外科杂志, 2007,7(7):593-595.
[43] Wang LX, Fu WG, Guo DQ, et al. Staged and hybrid approach in the treatment of complex aortic dissection[J].Chin Med J(Engl), 2008,121 (15):1492-1496.
[44] Bedi HS, Sengar BS, Sheth R. Innovative hybrid procedure for dissection thoracic aorta in a patient with a previous bentall operation[J]. Indian Heart J, 2008,60(1):61-63.
[45] Dias RR, Silva IA, Fiorelli AI, et al. New surgical strategy for acute type A aortic dissection: hybrid procedure[J]. Rev Bras Cir Cardiovasc, 2007, 22(4):495-497.
[46]黄强,徐平,郝传吉,等. "杂交技术"治疗复杂主动脉病变的效果[J].齐鲁医学杂志, 2008,23(5):403-407.
[47]易定华,刘维永,张近宝,等.胸主动脉瘤外科综合治疗[J].中国微创外科杂志, 2007,7(7):596-597.
[48] Dai XF, Chen LW, Chen DZ, et al. Analysis of surgical treatment for Standford type A aortic dissection[J]. Zhonghua Wai Ke Za Zhi, 2008, 46(11):823-825.
[49] Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation, 2003;12:772–778.
[50] Okamoto Y, Tsuchiya K, Nakajima M, et al. Surgical treatment of thoracic aortic disease combined with coronary artery bypass grafting operation[J]. Kyobu Geka, 2008,61(12):999-1002.
[51] Hayter RG, Rhea JT, Small A, et al. Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting[J]. Radiology, 2006,238:841-852.
[52] Fisher ER, Stern EJ, Gidwing JD, et al. Acute aortic dissection: typical and atypical imaging features[J]. Radio Graphics, 1994,14:1263–1271.
[53] Raptopoulos VD, Boiselle PB, Michailidis N. MDCT angiography of acute chest pain: evaluation of ecg-gated and nongated techniques[J]. Am J Roentgenol, 2006,186:S346–356.
[54] Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD) [J]. Am J Cardiol, 2002,89:1235- 1238.
[55]杜渭清,张雪林,郑敏文,等.多层螺旋CT在主动脉夹层的临床应用[J].第四军医大学学报, 2007, 28(21):2000-2003.
[56]孙清荣,文利,邹利光,等.螺旋CT血管造影诊断主动脉瘤的价值[J].第三军医大学学报, 2005,27(9):925-927.
[57] Rist C, Johnson TR, Becker CR, et al. New applications for noninvasive cardiac imaging: dual-source computed tomography[J]. Eur Radiol. 2007, 17(Suppl 6):F16-25.
[58] Ten Kate GJ, Weustink AC, de Feyter PJ. Coronary artery anomalies detected by MSCT-coronary angiography in the adult[J].Neth Heart J, 2008,16(11):369-375.
[59] Chandarana H, Godoy MC, Vlahos I, et al. Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms--initial observations[J].Radiology, 2008,249(2):692-700.
[60] Stolzmann P, Frauenfelder T, Pfammatter T, et al. Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT[J]. Radiology, 2008,249(2):682-691.
[61] Thorsten RC, Konstantin N, Alexander B, et al. Dual-source CT for chest pain assessment[J]. Eur Radiol, 2008,18(4):773-780.
[62] Heye T, Karck M, Richter G, et al. Visualization of entry and re-entry tears in a complex type A aortic dissection by 64-slice dual-source computer tomography[J]. Eur J Cardiothorac Surg, 2007,32(6):935-942.
[63] Johnson TR, Nikolaou K, Fink C, et al. Dual-source CT in chest pain diagnosis[J]. Radiologe, 2007,47(4):301-309.
[64] Stephan Achenbach. Contrast-enhanced coronary artery visualization by dual-source computed tomography initial experience[J]. European Journal of Radiology, 2006,1:1-5.
[65] Flohr TG, Stierstorfer K, Ulzheimer S, et al. Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot[J]. Med Phys, 2005,32:2536-2547.
[66] Flohr TG, Schaller S, Stierstorfer K, et al. Multi-detector row CT systems and image-reconstruction techniques[J]. Rediology, 2005,235:756-773.
[67] Wintersperger BJ, Nikolaou K, von Ziegler F, et al. Image quality, motion artifacts, and reconstruction timing of 64-slice coronary computed tomography angiography with 0.33-second rotation speed[J]. Invest Radiol, 2006,41:436-442.
[68] Johnson TR, Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT: initial experience[J]. Eur Radiol, 2007,17:1510-1517.
[69]曲崛.双源螺旋CT在心脏冠状动脉成像中的应用研究[J].实用医技杂志, 2007,6(3):292-293.
[70]张竹花,金征宇,李冬晶,等.多层螺旋CT冠脉成像的研究[J].中华放射学杂志, 2003,37(特刊):147-152.
[71] Chow LC, Rubin GD. CT angiography of the arterial system[J]. Radiol Clin North Am, 2002,40(4):729-749.
[72] Rubin GD. Techniques for performing multidetector-row computed tomographic angiogrpahy.Techniques in Vascular and Interventional Radiology, 2001,4(1):2-14.
[73] Rubin GD, Shiau MC, Leung AN, et al. Aorta and Iliac Arteries:single versus multiple detector-row helical CT angiography[J]. Radiology, 2000, 215(3):670-676.
[74] Nikolaou K, Knez A, Rist C,et al. Accuracy of 64-MDCT in the diagnosis of ischemic heart disease[J]. Am J Roentgenol, 2006,187:111–117.
[75] Kilian E, Beiras-Fernandez A, Bauerfeind D, et al. Intraoperative coronary angiography in the management of patients with acute aortic dissection and endocarditis[J]. J Thorac Cardiovasc Surg, 2008,136(3): 792-793.
[76] Johnson TRC, Nikolaou K, Wintersperger BJ,et al. ECG gated 64 slice CT angiography for the differential diagnosis of acute chest pain[J]. Am J Roentgenol, 2007,188:76-82.
[77] White CS, Kuo D, Kelemen M, et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation [J]? Am J Roentgenol, 2005,185:533–540.
[78] Johnson TR, Nikolaou K, Wintersperger BJ, et al. Dual-source CT cardiac imaging: initial experience[J]. Eur Radiol, 2006,16:1409–1415.
[79] Choi HS, Choi BW, Choe KO, et al. Pitfalls, artifacts, and remedies in multi-detector row CT coronary angiography[J]. Radio Graphics, 2004,24: 787-800.
[80] Hofmann LK, Zoo KH, Costello P, et al. Electrocardiographically gated 16-section CT of the thorax: cardiac motion suppression[J]. Radiology, 2004,233:927-933.
[81] Morgan-Hughes GJ, Owens PE, Marshall AJ, et al. Thoracic aorta at multi–detector row CT: motion artifact with various reconstruction windows[J]. Radiology, 2003,228:583–588.
[82] Ko SF, Hsieh MJ, Chen MC, et al. Effects of heart rate on motion artifacts of the aorta on non-ECG assisted 0.5-sec thoracic MDCT[J]. Am J Roentgenol, 2005,184:1225–1230.
[83] Manghat NE, Morgan-Hughes GJ, Roobottom CA. Multi-detector row computed tomography: imaging in acute aortic syndrome[J]. Clin Radiol, 2005, 60:1256-1267.
[84] Roos JE, Willmann JK, Weishaupt D, et al. Thoracic aorta: motion artifact reduction with retrospective and prospective electrocardiography-assisted multi-detector row CT[J]. Radiology, 2002,222:271-277.
[85] Cademartiri F, Pavone P. Advantages of retrospective ECG-gating in cardio-thoracic imaging with 16-row multislice computed tomography[J]. Acta Biomed, 2003,74:126–130.
[86] Batra P, Bigoni B, Manning J, et al. Pitfalls in the diagnosis of thoracic aortic dissection at CT angiography[J]. Radio Graphics, 2000,20:309-320.
[87] Rubin G. Helical CT angiography of the thoracic aorta[J].Thorac Imaging, 1997,12:128-149.
[88] Schoepf UJ, Holzknecht N, Helmberger TK, et al. Subsegmental pulmonary emboli: improved detection with thin-collimation multi- detector row spiral CT[J]. Radiology, 2002,222:483–490.
[89] Montaudon M, Berger P, Blachere H, et al. Thin-section CT of the lung: influence of 0.5-s gantry rotation and ECG triggering on image quality[J]. Eur Radiol, 2001,11:1681-1687.
[90] Schoepf UJ, Becker CR, Bruening RD, et al. Electrocardiographically gated thinsection CT of the lung[J]. Radiology, 1999,212:649-654.
[91] Nieman K, Oudkerk M, Rensing BJ, et al. Coronary angiography with multi-slice computed tomography[J]. Lancet, 2001,357:599-603.
[92] Willmann J, Weishaupt D, Lachat M, et al. Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis[J]. Radiology, 2002,225:120-128.
[93] Hong C, Becker CR, Huber A, et al. ECG gated reconstructed multi–detector row CT coronary angiography: effect of varying trigger delay on image quality[J]. Radiology, 2001,220:712-717.
[94] von BA, Dilger M, Fink T. Acute aortic dissection-vascular emergency with numerous pitfalls[J]. Vasa, 2008,37(1):53-59.
[95] Ricotta JJ, Pagan J, Xenos M,et al. Cardiovascular disease management: the need for better diagnostics[J]. Med Biol Eng Comput, 2008,46(11): 1059-1068.
[96] Elmali M, Gulel O, Bahcivan M. Coexistence of pulmonary embolism, aortic dissection, and persistent left superior vena cava in the same patient[J]. Cardiovasc Med, 2008,9(11):1180-1181.
[97] Pepi M, Campodonico J, Galli C, et al. Rapid diagnosis and management of thoracic aortic dissection and intramural haematoma: a prospective study of advantages of multiplane vs. biplane transoesophageal echocardiography[J]. Eur Echocardiogr, 2000,1:72-79.
[98] Nienaber CA, von Kodolitsch Y, Brockhoff CJ, et al. Comparison of conventional and transesophageal echocardiography with magnetic resonance imaging for anatomical mapping of thoracic aortic dissection. A dual noninvasive imaging study with anatomical and/or angiographic validation[J]. Int J Card Imaging, 1994,10:1-14.
[99] Losi MA, Betocchi S, Briguori C, et al. Determinants of aortic artifacts during transesophageal echocardiography of the ascending aorta[J]. Am Heart J, 1999,137:967-972.
[100] Wojciuk J, Hoadley GM, Brack MJ. Images in vascular medicine. Marfan syndrome-aortic dissection type A, visualized by computed tomography angiography[J]. Vasc Med, 2008,13(1):87-88.
[101] Katrina FH, James D. The utility of multiple imaging modalities to diagnose acute aortic dissection[J]. CJEM, 2008,10(1):75-80.
[102] Shiga T, Wajima Z, Apfel CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection:Systematic review and meta-analysis[J]. Arch Intern Med, 2006,166:1350 -1356
[103] Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection[J]. Am J Cardiol 2007,15,99(6):852-856.
[104]蒋俊豪,王玉琦,符伟国.血管内超声显像在诊断主动脉夹层动脉瘤中的应用[J].中华外科杂志, 2003,41(7):491-494.
[105] Keren A, Kim CB, Hu BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma[J]. J Am Coll Cardiol, 1996,28:627- 636.
[106] Vignon P, Gueret P, Vedrinne JM, et al. Role of transesophageal echocardiography in the diagnosis and management of traumatic aortic disruption[J]. Circulation, 1995,92:2959-2968.
[107] Vignon P, Spencer KT, Rambaud G, et al. Differential transesophageal echocardiographic diagnosis between linear artifacts and intraluminal flap of aortic dissection or disruption[J]. Chest, 2001,119:1778-1790.
[108] Yavuz S, Eris C, Turk T. Severe aortic regurgitation caused by a prolapsed circumferential intimal flap in acute type A aortic dissection: role of intraoperative transesophageal echocardiography[J]? Cardiothorac Vasc Anesth, 2008,22(6):941-945.
[109] Shiga T, Wajima Z, Inoue T, et al. Survey of observer variation in transesophageal echocardiography: comparison of anesthesiology and cardiology literature[J]. Cardiothorac Vasc Anesth, 2003,17:430-442.
[110] Gani F, Jain D, Lahiri A. The role of cardiovascular imaging techniques in the assessment of patients with acute chest pain[J]. Nucl Med Commun, 2007,28:441–449.
[111] Kwong RY, Schussheim AE, Rekhraj S, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging[J]. Circulation, 2003,107:531–537.
[112] Kumar A, Friedrich MG. Acute chest pain syndrome: will MRI shake up cardiovascular care in the emergency room[J]? Expert Review Of Cardiovascular Therapy, 2007,5:139–141.
[113] Cohen R, Sfaxi A, Foucher R, et al. Iatrogenic acute aortic dissection during percutaneous coronary intervention for acute myocardial infarction[J]. Acute Card Care, 2008,10(3):191-192.
[114] Stephan K, Ibrahim A, Hüseyin I, et al. Stent-graft repair in acute and chronic diseases of the thoracic aorta[J]. Esp Cardiol, 2008,61(10):1070- 1086.
[115] Chiles C, Carr JJ. Vascular diseases of the thorax: evaluation with multidetector CT[J]. Radiol Clin North Am, 2005,43:543-569.
[116] Scheffel H, Alkadhi H, Plass A, et al. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control[J]. Eur Radiol, 2006,16:2739-2747.
[117] Ganaha F, Miller DC, Sugimoto K, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis[J]. Circulation, 2002,106(3):342-348.
[118] Kodolitsch Y, Nienaber CA. Intramural hemorrhage of the thoracic aorta: diagnosis, therapy and prognosis of 209 in vivo diagnosed cases[J]. Z Kardiol, 1998(12);87:797-807.
[119] Thomas TT, Arturo E, Christoph AN, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection[J]. N Engl Med, 2007,357(4):349-359.
[120] Takagi H, Kawai N, Umemoto T, et al. Partial thrombosis of the false lumen in aortic dissection[J]. N Engl Med, 2007,357:1868-1869.
[121] Blaivas M, Sierzenski PR. Dissection of the proximal thoracic aorta: a new ultrasonographic sign in the subxiphoid view[J]. Am Emerg Med, 2002(4),20:344-348.