活动性大动脉炎主动脉CT血管成像的影像特征  

Imaging characteristics of CT angiography of the aorta in active Takayasu arteritis

作　　者：王佳[1] 牛俊巧[1] 李晓娟 刘焱[1] Wang Jia;Niu Junqiao;Li Xiaojuan;Liu Yan(Radiographic Imaging Center,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院放射影像中心,乌鲁木齐830001

出　　处：《中华风湿病学杂志》2023年第12期806-813,I0002,共9页Chinese Journal of Rheumatology

基　　金：新疆维吾尔自治区自然科学基金(2019D01C153);新疆维吾尔自治区人民医院院内基金(20190314)。

摘　　要：目的探讨活动性大动脉炎主动脉CT血管成像(CTA)的影像特征及临床价值。方法回顾性分析2015年1月至2022年10月新疆维吾尔自治区人民医院风湿免疫科收治的77例大动脉炎(TAK)患者的临床资料、实验室检查结果,分为2组,TAK活动组62例,TAK非活动组15例。其中17例患者进行随访,13例转为非活动性,4例仍为活动性,共94次主动脉CTA影像结果,分为2组,TAK活动组66例次,TAK非活动组28例次。所有患者均行胸腹部CT平扫、主动脉CTA及其后处理检查,其中12例活动性TAK患者行主动脉增强延迟期扫描。采用t检验、Mann-Whitney U检验、χ^(2)检验、Fisher确切概率法及Pearson/Spearman相关性分析,测量、比较2组的影像学特征,分析影像特征与实验室结果、Kerr评分的相关性,评估影像特征的诊断效能,观察治疗前后影像特征变化,分析活动性TAK患者主动脉增强延迟期影像特点。结果TAK活动组与非活动组病程[14(1,29)个月]和[33(8,69)个月,Z=2.70,P=0.007]、身体不适或体质量减轻症状发生率[32.3%(20/62)和20.0%(3/15),χ^(2)=4.08,P=0.043]、ESR增快率[98.4%(61/62)和13.3%(2/15),χ^(2)=64.69,P<0.001]、CRP升高率[69.4%(43/62)和6.7%(1/15),χ^(2)=29.94,P<0.001]比较差异均具有统计学意义,2组血管壁厚度值[(4.2±1.4)mm和(2.4±0.8)mm,t=7.81,P<0.001)]、动脉期管壁CT_(mean)值[(81±8)Hu和(70±13)Hu,t=2.82,P=0.011]、动脉期管壁CT_(max)值[(106±12)Hu和(96±12)Hu,t=2.38,P=0.024]、动脉期管壁相对CT值1(0.20±0.08和0.14±0.04,t=2.56,P=0.016)、动脉期管壁相对CT值2(1.23±0.18和1.06±0.17,t=2.63,P=0.013)、主动脉周围脂肪组织CT_(mean)值[(-31±12)Hu和(-58±20)Hu,t=4.80,P<0.001]、主动脉周围脂肪组织CT_(max)值[-35(-45,-25)Hu和-87(-95,-42)Hu,Z=4.27,P<0.001]、分支周围脂肪组织CT_(mean)值[-28(-33,-14)Hu和-76(-83,-31)Hu,Z=3.37,P=0.001]、分支周围脂肪组织CT_(max)值[-7(-13,-1)Hu和-59(-72,-14)Hu,Z=3.74,P<0.001]、主动脉周围脂肪组织相对CT值(Objective To explore the imaging characteristics and clinical value of CT angiography(CTA)of the aorta in active arteritis.Methods A retrospective analysis was conducted on the clinical data and laboratory examination results of 77 patients with Takayasu arteritis(TAK)admitted to the Rheumatology and Immunology Department of People′s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to October 2022.They were divided into two groups:62 cases in the TAK active group and 15 cases in the TAK inactive group.Among them,17 patients were followed up,13 cases became inactive,and 4 cases remained active.A total of 94 aortic CTA imaging results were divided into 2 groups,with 66 cases in the TAK active group and 28 cases in the TAK inactive group.All patients underwent plain chest and abdominal CT scans,aortic CTA,and post-processing examinations,with 12 active TAK patients undergoing delayed aortic enhancement scans.The t-test,Mann Whitney U test,χ^(2)Testing,Fisher′s exact probability method and Pearson/Spearman correlation analysis were used for data analysis.The imaging features of the two groups were measured and compared,the correlation between imaging features and laboratory results,Kerr score were investigated.The diagnositic efficacy of imaging features were explored and imaging features before and after treatment were analyzed.Results In the TAK active and inactive groups,course of disease[14(1,29)months vs 33(8,69)months,Z=2.70,P=0.007],Physical malaise or weight loss[32.3%(20/62)vs 20.0%(3/15),χ^(2)=4.08,P=0.043],increased ESR[98.4%(61/62)vs 13.3%(2/15),χ^(2)=64.69,P<0.001],CRP level[69.4%(43/62)vs 6.7%(1/15),χ^(2)=29.94,P<0.001]were statistically significant.The vascular wall thickness of the two groups was significantly different[(4.2±1.4)mm vs(2.4±0.8)mm,t=7.81,P<0.001],CT_(mean) value of the garterial wall[(81±8)Hu vs(70±13)Hu,t=2.82,P=0.011],CT_(max)value of the arterial wall[(106±12)Hu vs(96±12)Hu,t=2.38,P=0.024],relative CT value 1 of the arterial wall(0.20±0.08 vs 0.14±0.04,t

关 键 词：TAKAYASU动脉炎 主动脉 体层摄影术 X线计算机 

分 类 号：R543.5[医药卫生—心血管疾病] R816.2[医药卫生—内科学]