主动脉夹层破口检出的影像学进展及临床应用
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摘要
主动脉夹层是急性主动脉综合征之一,是一种严重危及生命的疾病。主动脉夹层中破口位置和内膜片撕裂范围不仅仅是临床分型的主要依据,而且在指导血管内修复术操作位置与范围中也起着举足轻重的作用。随着科学技术的不断发展,多层螺旋CT血管造影及其他影像学检查在主动脉夹层破口的显示及诊断上也有了长足的进步。本文对诊断主动脉夹层和检出破口的各种影像学方法的进展进行综述,总结各种影像学方法在检测主动脉夹层破口的临床价值。
Aortic dissection is one of the acute aortic syndrome, which is a serious life-threatening disease. The location of the rupture of aortic dissection and intimal tear not only is mainly basis of the clinical classification, but also plays an important role in the guidance of operation position and range of endovascular repair. With the continuous development of science and technology, multislice spiral CT angiography and other imaging examination has made considerable progress in the diagnosis of aortic dissection and display. This paper reviews the progress of various imaging methods in diagnosis of aortic dissection and detection of the rupture, and summarizes the clinical value of different imaging methods in the detection of rupture of aortic dissection.
Aortic dissection is one of the acute aortic syndrome, which is a serious life-threatening disease. The location of the rupture of aortic dissection and intimal tear not only is mainly basis of the clinical classification, but also plays an important role in the guidance of operation position and range of endovascular repair. With the continuous development of science and technology, multislice spiral CT angiography and other imaging examination has made considerable progress in the diagnosis of aortic dissection and display. This paper reviews the progress of various imaging methods in diagnosis of aortic dissection and detection of the rupture, and summarizes the clinical value of different imaging methods in the detection of rupture of aortic dissection.
引文
[1]李金燕,张国伟,王锡明,等.大螺距三联个体化对比剂方案在胸痛患者检查中的价值分析[J].中华医学杂志,2015,95(29):2363-2367.
[2]徐昶,贺行巍,李柱锡军,等.主动脉夹层症状与原发破口位置、撕裂范围关系的探讨[J].内科危重症杂志,2015,21(4):266-268.
[3]Del Porto F,di Gioia C,Tritapepe L,et al.The multitasking role of macrophages in Stanford A acute aortic dissection[J].Cardiology,2014,127(2):123-129.
[4]易定华,段维勋.中国主动脉夹层诊疗现状与展望[J].中国循环杂志,2013,28(1):12.
[5]王巍巍,张畔,王峪.急性主动脉夹层的早期诊断策略[J].中国急救医学,2013,33(1):5356.
[6]汤振华.64层螺旋CT血管成像在主动脉夹层动脉瘤的诊断价值[J].中国CT和MRI杂志,2012,10(3):43-45.
[7]Souza D,Ledb etter S.Diagnostic errors in the evaluation of nontraumatic aortic emergencies[J].Semin Ultraound CT MR,2012,33(3):318-326.
[8]朱玉春,王建良,吴志娟,等.升主动脉搏动样伪影的螺旋CT表现及其消除措施[J].临床放射学杂志,2013,32(4):573-576.
[9]李宇,许尚栋,张楠,等.前瞻性心电门控大螺距血管成像技术对Stanford A型主动脉夹层根部病变的诊断价值[J].中国医刊,2016,51(12):1304-1308.
[10]Zhao L,Wang ZF,Liu AS.Triple-rule-out computed tomographic angiography with prospective ECG gating:A clinical study in chest pain patients with heart rate lower than 75 bpm[J].J Clin Radiol,2012,31(6):883-887.
[11]Chiu KW,Lakshminarayan R,Ettles DF.Acute aortic syndrome:CT findings[J].Clin Radiol,2013,68(7):741-748.
[12]Bolen MA,Popovic ZB,Tandon N,et al.Image quality,contrast enhancement,and radiation dose of ECG-triggered high-pitch CT versus non-ECG-triggered standard-pitch CT of the thoracoabdominal aorta[J].Am J Roentgenol,2012,198(4):931-938.
[13]郑敏文,赵宏亮,徐健,等.多层螺旋CT主动脉低剂量与常规剂量扫描的对照研究[J].中国医学影像技术,2008,24(3):443-446.
[14]李剑,郑敏文,石明国,等.低k V和CAREDose4D技术对降低双源CT主动脉成像辐射剂量的价值[J].临床放射学杂志,2011,30(10):1528-1531.
[15]Cornfeld D,Israel G,Detroy E,et al.Impact of adaptive statistical iterative Reconstruction(ASIR)on radiation dose and image quality in aortic dissection studies:A qualitative and quantitative analysis[J].AJR Am J Roentgenol,2001,196(3):336-340.
[16]姜丽丽,张丽.双源CT低剂量扫描联合迭代重建在主动脉夹层中的应用[J].临床影像标准学研究,2015,29(131):178-180.
[17]邹新华,李文武.双源光子CT大螺距、低辐射剂量、低对比剂用量扫描方案在主动脉夹层病变中的应用[J].中国CT和MRI杂志,2016,6(14):35-37.
[18]林少帆,吴先衡,林黛英,等.多层螺旋CT血管成像在评估主动脉夹层内膜破口中的应用研究[J].实用医用杂志,2013,4(4):363-365.
[19]董健,高莉,王霄英,等.迭代重建对肺肿块低剂量CT灌注成像参数的影响[J].放射学实践,2013,28(3):280-283.
[20]张祺丰,彭芸,段晓岷,等.应用自适应统计迭代重建技术降低儿童腹部多层螺旋CT辐射剂量[J].中华放射学杂志,2013,47(2):112-115.
[21]陈亮,杨剑,刘金成,等.双源CT术前评估胸主动脉夹层破口的对照研究[J].第四军医大学学报,2009,30(10):953-956.
[22]Bamberg F,Marcus R,Sommer W,et al.Diagnostic image quality ofa comprehensive high-pitch dual-spiral cardiothoracic CT protocolin patients with undifferentiated acute chest pain[J].Eur J Radiol,2012,81(6):3697-3702.
[23]王利伟,殷信道,王绍娟,等.多层螺旋CT三维重建技术诊断急性主动脉夹层的价值[J].实用放射学杂志,2012,28(6):856-859.
[24]Lell M,Marwan M,Schepis T,et al.Prospectively ECGtriggered high-pitch spiral acquisition for coronary CT angiography using dual source CT:technique and initial experience[J].Eur Radiol,2009,19(11):2576-2583.
[25]Members AF,Erbel R,Aboyans V,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J].Eur Heart J,2014,72(41):1169-1252.
[26]Bhatla P,Nielsen JC.Cardiovascular magnetic resonance as an alternate method for serial evaluation of proximal aorta:comparison with echocardiography[J].Echocardiography,2013,30(6):713-718.
[27]Karlo C,Leschka S,Goetti RP,et al.High-pitch dualsource CT angiography of the aorticvalve-aortic root complex without ECG-synchronization[J].Eur Radiol,2011,21(1):205-212.
[28]Litmanovich D,Bankier AA,Cantin L,et al.CT and MRI in diseases of the aorta[J].Ajr Am J Roentgenol,2009,193(4):928-940.
[29]Nienaber CA.The role of imaging in acute aortic syndromes[J].Eur Heart J Cardiovasc Imaging,2012,14(1):15-23.
[30]Gordic S,Morsbach F,Schmidt B,et al.Ultralow-dose chest computed tomography for pulmonary nodule detection:first performance evaluation of single energy scanning with spectral shaping[J].Invest Radiol,2014,49(7):465-473.
[31]谭仲伦,成官迅,郭晓婷,等.1.5T磁共振TWIST技术在主动脉夹层的应用研究[J].医学影像学杂志,2016,26(5):812-815.
[32]JJánosi RA,Erbel R,Konorza TF.Recent advances in the diagnosis of acute aortic syndromes[J].Expert Opin Med Diagn,2012,6(6):529-540.
[33]Evangelista A,Carro A,Moral S,et al.Imaging modalities for the early diagnosis of acute aortic syndrome[J].Nat Rev Cardiol,2013,10(8):477.
[34]段利科,张周龙,陈胜江.彩色多普勒超声诊断急性主动脉夹层的临床价值[J].医学影像,2013,51(9):104-105.
[2]徐昶,贺行巍,李柱锡军,等.主动脉夹层症状与原发破口位置、撕裂范围关系的探讨[J].内科危重症杂志,2015,21(4):266-268.
[3]Del Porto F,di Gioia C,Tritapepe L,et al.The multitasking role of macrophages in Stanford A acute aortic dissection[J].Cardiology,2014,127(2):123-129.
[4]易定华,段维勋.中国主动脉夹层诊疗现状与展望[J].中国循环杂志,2013,28(1):12.
[5]王巍巍,张畔,王峪.急性主动脉夹层的早期诊断策略[J].中国急救医学,2013,33(1):5356.
[6]汤振华.64层螺旋CT血管成像在主动脉夹层动脉瘤的诊断价值[J].中国CT和MRI杂志,2012,10(3):43-45.
[7]Souza D,Ledb etter S.Diagnostic errors in the evaluation of nontraumatic aortic emergencies[J].Semin Ultraound CT MR,2012,33(3):318-326.
[8]朱玉春,王建良,吴志娟,等.升主动脉搏动样伪影的螺旋CT表现及其消除措施[J].临床放射学杂志,2013,32(4):573-576.
[9]李宇,许尚栋,张楠,等.前瞻性心电门控大螺距血管成像技术对Stanford A型主动脉夹层根部病变的诊断价值[J].中国医刊,2016,51(12):1304-1308.
[10]Zhao L,Wang ZF,Liu AS.Triple-rule-out computed tomographic angiography with prospective ECG gating:A clinical study in chest pain patients with heart rate lower than 75 bpm[J].J Clin Radiol,2012,31(6):883-887.
[11]Chiu KW,Lakshminarayan R,Ettles DF.Acute aortic syndrome:CT findings[J].Clin Radiol,2013,68(7):741-748.
[12]Bolen MA,Popovic ZB,Tandon N,et al.Image quality,contrast enhancement,and radiation dose of ECG-triggered high-pitch CT versus non-ECG-triggered standard-pitch CT of the thoracoabdominal aorta[J].Am J Roentgenol,2012,198(4):931-938.
[13]郑敏文,赵宏亮,徐健,等.多层螺旋CT主动脉低剂量与常规剂量扫描的对照研究[J].中国医学影像技术,2008,24(3):443-446.
[14]李剑,郑敏文,石明国,等.低k V和CAREDose4D技术对降低双源CT主动脉成像辐射剂量的价值[J].临床放射学杂志,2011,30(10):1528-1531.
[15]Cornfeld D,Israel G,Detroy E,et al.Impact of adaptive statistical iterative Reconstruction(ASIR)on radiation dose and image quality in aortic dissection studies:A qualitative and quantitative analysis[J].AJR Am J Roentgenol,2001,196(3):336-340.
[16]姜丽丽,张丽.双源CT低剂量扫描联合迭代重建在主动脉夹层中的应用[J].临床影像标准学研究,2015,29(131):178-180.
[17]邹新华,李文武.双源光子CT大螺距、低辐射剂量、低对比剂用量扫描方案在主动脉夹层病变中的应用[J].中国CT和MRI杂志,2016,6(14):35-37.
[18]林少帆,吴先衡,林黛英,等.多层螺旋CT血管成像在评估主动脉夹层内膜破口中的应用研究[J].实用医用杂志,2013,4(4):363-365.
[19]董健,高莉,王霄英,等.迭代重建对肺肿块低剂量CT灌注成像参数的影响[J].放射学实践,2013,28(3):280-283.
[20]张祺丰,彭芸,段晓岷,等.应用自适应统计迭代重建技术降低儿童腹部多层螺旋CT辐射剂量[J].中华放射学杂志,2013,47(2):112-115.
[21]陈亮,杨剑,刘金成,等.双源CT术前评估胸主动脉夹层破口的对照研究[J].第四军医大学学报,2009,30(10):953-956.
[22]Bamberg F,Marcus R,Sommer W,et al.Diagnostic image quality ofa comprehensive high-pitch dual-spiral cardiothoracic CT protocolin patients with undifferentiated acute chest pain[J].Eur J Radiol,2012,81(6):3697-3702.
[23]王利伟,殷信道,王绍娟,等.多层螺旋CT三维重建技术诊断急性主动脉夹层的价值[J].实用放射学杂志,2012,28(6):856-859.
[24]Lell M,Marwan M,Schepis T,et al.Prospectively ECGtriggered high-pitch spiral acquisition for coronary CT angiography using dual source CT:technique and initial experience[J].Eur Radiol,2009,19(11):2576-2583.
[25]Members AF,Erbel R,Aboyans V,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J].Eur Heart J,2014,72(41):1169-1252.
[26]Bhatla P,Nielsen JC.Cardiovascular magnetic resonance as an alternate method for serial evaluation of proximal aorta:comparison with echocardiography[J].Echocardiography,2013,30(6):713-718.
[27]Karlo C,Leschka S,Goetti RP,et al.High-pitch dualsource CT angiography of the aorticvalve-aortic root complex without ECG-synchronization[J].Eur Radiol,2011,21(1):205-212.
[28]Litmanovich D,Bankier AA,Cantin L,et al.CT and MRI in diseases of the aorta[J].Ajr Am J Roentgenol,2009,193(4):928-940.
[29]Nienaber CA.The role of imaging in acute aortic syndromes[J].Eur Heart J Cardiovasc Imaging,2012,14(1):15-23.
[30]Gordic S,Morsbach F,Schmidt B,et al.Ultralow-dose chest computed tomography for pulmonary nodule detection:first performance evaluation of single energy scanning with spectral shaping[J].Invest Radiol,2014,49(7):465-473.
[31]谭仲伦,成官迅,郭晓婷,等.1.5T磁共振TWIST技术在主动脉夹层的应用研究[J].医学影像学杂志,2016,26(5):812-815.
[32]JJánosi RA,Erbel R,Konorza TF.Recent advances in the diagnosis of acute aortic syndromes[J].Expert Opin Med Diagn,2012,6(6):529-540.
[33]Evangelista A,Carro A,Moral S,et al.Imaging modalities for the early diagnosis of acute aortic syndrome[J].Nat Rev Cardiol,2013,10(8):477.
[34]段利科,张周龙,陈胜江.彩色多普勒超声诊断急性主动脉夹层的临床价值[J].医学影像,2013,51(9):104-105.