急性StanfordA型主动脉夹层累及冠状动脉的术前MSCTA评估  

The Evaluation of Preoperative MSCTA in Acute Stanford Type AAortic Dissection with Coronary Involvement

作　　者：许娟[1] 马小静 胡道予[2] 陈艳[1] 蔡仁慧 XU Juan;MA Xiao-jing;HU Dao-yu;CHEN Yan;CAI Ren-hui(Department of Radiology,Wuhan Asia Heart Hospital,Wuhan 430022,Hubei Province,China;Department of Radiology,Tongji hospital,Huazhong University of Science and Technology,Wuhan 430030,Hubei Province,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院放射科,湖北武汉430022 [2]华中科技大学附属同济医院放射科,湖北武汉430030

出　　处：《中国CT和MRI杂志》2023年第3期79-81,共3页Chinese Journal of CT and MRI

基　　金：基于冠状动脉粥样硬化性心脏病CTA影像诊断的人工智能研究(2019020701011422)。

摘　　要：目的评估急性Stanford A型主动脉夹层累及冠状动脉的多层螺旋CT血管成像(MSCTA)特征及术前诊断价值。方法回顾性分析2015年1月至2021年10月A型主动脉夹层且术前行MSCTA扫描的374例患者资料,手术证实冠状动脉受累107例。结果将手术作为金标准,MSCTA诊断右冠状动脉(RCA)受累的敏感性、特异性、阳性预测值、阴性预测值分别为84.2%、98.6%、95.2%、94.8%,Kappa=0.854;左冠状动脉(LCA)分别为88.9%、100%、100%、98.5%,Kappa=0.934。冠状动脉受累分为三种情况,Neri A型56例(开口夹层),Neri B型20例(夹层的内膜撕裂延伸进入管腔内),Neri C型15例(开口离断)。RCA受累的患病率高于LCA(P<0.001)。在三种病变类型中受累侧有显著差异:Neri A型和C型多发生在RCA(P<0.05)。结论MSCTA可以准确辨别冠状动脉受累特征,有助于临床术前早期诊断,帮助术者合理选择手术方式,改善预后。Objective To evaluate the characteristics and preoperative diagnostic value of multi-slice spiral CT angiography(MSCTA)of acute Stanford A aortic dissection involving coronary arteries.Methods The data of 374 patients with acute Stanford type A aortic dissection and MSCTA scan before surgery were analyzed retrospectively from January 2015 to October 2021,107 cases of coronary involvement were confirmed by operation.Results Taking surgery as the gold standard,the sensitivity,specificity,positiv e predictive value and negative predictive value of MSCTA for the diagnosis of RCA involvement were 84.2%,98.6%,95.2%and 94.8%,respectively,kappa=0.854;The above 4 indexes of LCA involvement were 88.9%,100%,100%and 98.5%,respectively,Kappa=0.934.Coronary involvement were divided into three types,type Neri A lesion in 52 cases(ostial dissection);type Neri B lesion in 16 cases(dissection with intimal tearing into the inner of the coronary);type Neri C lesion in 11 cases(ostial detachment).The RCA was more frequently affected than the LCA(P<0.001).The side of the affected CA differed significantly among the three lesion types:the RCA was more commonly affected in patients with type A lesion and type C lesion(P>0.05).Conclusio n MSCTA can accurately distinguish the characteristics of coronary involvement,and is helpful for early diagnosis before operation,reasonable selection of operation methods and improving prognosis.

关 键 词：主动脉夹层 主动脉夹层累及冠状动脉 冠状动脉受累 灌注不良 心肌梗死 X线计算机 

分 类 号：R445.3[医药卫生—影像医学与核医学]