多层螺旋CT造影在主动脉病变腔内修复术后随访的价值  

The clinical value of MDCT in the follow-up of aortic endovascular interventional therapy

作　　者：李炯佾[1] 杨呈伟[1] 胡海波[2] 曹文娟[1] 徐伟[1] 张浩[1] 张维明[1] 王青[1] 赵玉红[1] 顾立君[1] 

机构地区：[1]青岛阜外心血管病医院放射科,山东青岛266034 [2]中国医学科学院阜外心血管病医院放射科,北京100037

出　　处：《医学影像学杂志》2010年第8期1105-1109,共5页Journal of Medical Imaging

基　　金：青岛市科技立项(编号:2009KZJ-13)

摘　　要：目的：探讨多层螺旋CT血管造影（multi-detector rowspiral computed tomography angiography,MDCTA）及后处理技术在主动脉覆膜支架腔内修复术（transluminal stent-graft placement,TSGP）术后随访的临床应用价值。方法：21例接受TSGP主动脉疾病患者,包括：Stanford B型夹层13例,真性动脉瘤3例,假性动脉瘤2例,弓降部穿透性溃疡1例,胸主动脉瘤合并局限性夹层1例,胸主动脉瘤合并Stanford B型夹层1例,术后采用MDCTA进行随访,平均随访13个月（1~24个月）。采用轴位图像与多种重建图像相结合来显示支架形态、术前术后主动脉管腔情况的变化和有无并发症。结果：13例主动脉夹层覆膜支架置入后：所有患者均真腔扩大,假腔减小或消失并伴血栓形成,支架未发现移位或断裂;共3例（14%）随访中发现内漏,1例Ⅱ型内漏,建议随访观察;1例术后8个月复查新发现支架近端Ⅰ型内漏,密切随访2个月后患者出现胸痛,复查CT内漏增多,转外科治疗。1例腹主动脉瘤术后1月复查发现Ⅲ型内漏。所有患者介入术后CT随访图像均满足临床诊断需要。结论：MDCTA对主动脉覆膜支架置入术后随访较其他检查手段具有多方面的优越性,能及时观察术后疗效、发现并发症,对主动脉疾病覆膜支架腔内修复术后随访具有重要价值。Objective：To evaluate the clinical value of multi-detector row spiral CT（MDCT） in the follw-up of aortic endovascular interventional therapy.Methods：Aortic lesions included 13 type B dissections,3 atherosclerotic aneurysms,2 pseudoaneurysm,1 penetrating ulcers,1 thoracic aorta with local dissection and 1 thoracic aorta with Stanford B dissection.All patients underwent transcatheter stent graft placement（TSGP）,and were performed MDCT angiography during the follow-up of average 13 months（1～24 months）.Results：In the follow-up MDCT showed that the position and the shape of all the stents was right,and the morphological changes of aortic lumen after TSGP was encouraged.Endoleak was observed in three（14%） patients： in one（typeⅡ）,it was persistent;in one（typeⅠ）,it was found on follow-up CTA after 8 months and treatment was converted to surgery;in one（typeⅢ） with abdominal aneurysm,it was found after 1 month.Conclusion：MDCT angiography has unique advantage for observation of morphological changes of aortic artery in follow-up of interventional therapy of various aortic disease,and it was the ideal examination in follow-up for those with TSGP.

关 键 词：主动脉夹层 主动脉瘤 腔内治疗 体层摄影术 X线计算机 

分 类 号：R541[医药卫生—心血管疾病] R814.42[医药卫生—内科学]