综合超声与磁共振成像对照评价主动脉夹层前瞻性研究  

A Prospective Study on Comparative Evaluation of Aortic Dissection With Echocardiography and Magnetic Resonance Imaging

作　　者：袁定华[1] 李守平[1] 杨浣宜[1] 刘汉英[1] 刘玉清[1] 王照谦 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院超声科

出　　处：《中国循环杂志》1997年第4期287-289,共3页Chinese Circulation Journal

基　　金：卫生部青年科学基金

摘　　要：目的：通过与磁共振成像对照研究，评价经胸超声心动图（ＴＴＥ）和经食管超声心动图（ＴＥＥ）在主动脉夹层的应用价值。方法：３９例经手术确诊或经磁共振成像、数字减影血管造影术及ＴＥＥ２种检查方法证实的３９例主动脉夹层患者。结果：ＴＴＥ、ＴＥＥ和磁共振成像诊断主动脉夹层，敏感性分别为９０％、１００％和９７％；特异性分别为９３％、９７％和１００％。ＴＴＥ主要不足在于对降主动脉夹层、原发破口和假腔血栓检出率偏低。ＴＥＥ在夹层破口、假腔血栓、主动脉瓣反流和冠状动脉的检查方面优于磁共振成像。而磁共振成像在头臂动脉及腹主动脉分支的检查方面优于ＴＥＥ。本研究显示主动脉夹层破口血流在收缩期从真腔进入假腔，舒张期又返回真腔。结论：①综合超声心动图和磁共振成像均是理想的主动脉夹层诊断方法；ＴＴＥ适合于筛选检查，ＴＥＥ有确诊价值。②主动脉夹层破口血流方向与真假腔压力变化有关，而与破口部位无关。Objective:To assess the value of both transthoracic echocardiography(TTE)and transesophageal(TEE)echocardiography in the diagnosis of aortic dissection as compared with magnetic resonance imaging(MRI). Methods:Thirty nine patients were diagnosed as aortic dissection by TTE and TEE and were proven by MRI,digital subtraction arteriography (DSA) or surgery. Results:The sensitivities of TTE,TEE and MRI in the diagnosis of aortic dissection were 90%,100% and 97%,and the specificities were 93%,97% and 100%,respectively.The drawback of TTE was the low detectable rate in the pathologies of descending aorta.The present results showed that TEE was more sensitive than MRI in detecting the sites of entry and reentry,the thrombus in the false lumen,aortic regurgitation,etc.MRI provided better visualization of truncus brachiocephalicus and the branches of abdominal aorta.The results also showed that the blood flow entered into the false lumen from the true lumen in systole and returned to the true lumen in diastole at both entry and reentry sites. Conclusions:①TTE,TEE and MRI are all useful in diagnosing aortic dissection with different advantages.TTE is suitable for routine screening,while TEE is for making a correct diagnosis.②The direction of blood flow at both entry and reentry sites is related to the changes of pressure in the true and false lumens during cardiac cycle.

关 键 词：超声心动图 主动脉夹层 NMR 成像 

分 类 号：R543.160.4[医药卫生—心血管疾病]