主动脉夹层多层螺旋CT血管成像诊断的应用研究
汕头大学硕士学位论文主动脉夹层多层螺旋CT 血管成像诊断的应用研究姓名：林少帆申请学位级别：硕士专业：影像医学与核医学指导教师：林顺发2010-05 汕头大学医学院硕士学位论文摘要目的探讨多层螺旋 CT（multi-slice computed tomography，MSCT）主动脉血管成像的最佳扫描技术，评价 MSCT在主动脉夹层（aortic dissection，AD）诊断中的应用价值；对血压水平与 AD内膜破口大小的关系作初步研究，分析高血压与 AD分型之间的关系；对双肾动脉受累方式的差异做比较研究，并对可能的原因进行初步探讨。材料与方法收集汕头大学医学院第一附属医院 2006年 12月至 2009年 6月经多层螺旋 CT血管造影（multi-slice computed tomography angiography，MSCTA）检查诊断为 AD 35例作为本课题研究对象。评价 MSCTA对 AD的诊断价值；对比研究多平面重建（ multiplannarreformation，MPR）、曲面重建（curved plannar reconstruction，CPR）、最大密度投影（maximumintensity projection，MIP）结合薄层 MIP、容积再现术（volume rendering，VR）结合薄层VR各种重建技术对 AD真假腔、内膜破口及内膜瓣的观察结果；将本组 35例按照假腔内有无血栓形成、内膜初始破口是否清晰及内膜瓣是否全程清晰 3种属性分别分组后对三种属性的关系进行研究，分析可能影响内膜破口观察的因素；同时对血压水平与内膜初始破口大小的关系作初步研究，分析高血压与 AD分型之间的关系；最后对双肾动脉受累方式的差异做比较研究并对可能的原因进行初步探讨。结果1. 35例均获得满意的 CT血管造影（computed tomography angiography, CTA）图像，以横断轴位图像为基础，综合运用各种重建技术，均能满足 AD的诊断要求。2. Stanford A型 AD患者与 Stanford B型患者间合并高血压的率无差别。3.“横断面积测量法”与“直径测量法”对真假腔大小的观察结果一致性高（Kappa系数k=0.720，p=0.002）。4. 28例内膜初始破口观察清晰的病例中真腔密度明显高于假腔者 17例，真腔密度与假腔相近者 11例，两组内膜初始破口大小有差别，前组内膜初始破口比后组小。5. MPR、CPR、MIP结合薄层 MIP、VR结合薄层 VR几种重建技术对于 AD真假腔、内膜破口及内膜瓣的观察结果无差别。6.内膜瓣显示情况与假腔内血栓形成关系密切（rs=0.573，p=0.001）；内膜初始破口与内I 汕头大学医学院硕士学位论文膜瓣显示情况关系密切（rs=0.739，p=0.000）；内膜初始破口显示情况与假腔内血栓形成有关联（rs=0.372，p=0.041）。7. AD内膜初始破口大小与收缩压大小无关（rs=-0.010，P=0.961）；内膜初始破口大小与舒张压大小也无关（rs=-0.070，p=0.746）；内膜初始破口大小与血压分级同样不存在相关关系（rs=-0.019，p=0.930）。8.右肾动脉以真腔供血较左肾动脉常见；左肾动脉以假腔供血较右肾动脉常见；双肾动脉以真、假腔同时供血的率无差别。9.双肾动脉夹角大小差别有显著性，右肾动脉夹角较左肾动脉夹角小。10.以肾动脉受累方式不同分组，各组间受累肾动脉的夹角大小无差别；以左肾动脉受累方式不同分组，各组间受累左肾动脉的夹角大小也无差别；以右肾动脉受累方式不同分组，各组间受累右肾动脉的夹角大小同样无差别。结论MSCTA对诊断 AD有重要的应用价值，所采集数据经重建及后处理后均能满足 AD的诊断要求，临床实际操作中应综合运用 MPR、CPR、MIP结合薄层 MIP、VR结合薄层VR等各种重建技术，以更好地发现病变；假腔内血栓形成是引起内膜破口观察不清的主要原因；AD内膜初始破口大小与血压水平无关，各型 AD患者间合并高血压的率无差别；AD累及双肾动脉的方式不尽相同，且与其夹角大小无明显关系。【关键词】主动脉夹层；多层螺旋 CT血管造影；血压水平；分支血管；肾动脉II 汕头大学医学院硕士学位论文AbstractObjectivesThe objectives of this study were to discuss and find out the best scanning technique formulti-slice comupted tomography(MSCT), to evaluate the application significance of MSCT onthe diagnosis of aortic dissection（AD）, to make a study on the correlation between the size ofintimal tear and the level of blood pressure, to analyze the relationship between the types of ADand hypertension, to focus on the comparison of different vascular invasions of both renalarteries and discuss the possible causes.Methods and materials35 patients checked up by MSCTA and diagnosed as AD in the First Affiliated Hospital ofShantou University Medical College during Dec.2006 to Jun.2009 were studied. To illustrate thediagnostic significance of MSCTA for AD and make comparison among the observational resultsfrom several reconstruction techniques such as MPR, CPR, MIP with MIP Thin and VR with VRThin. To figure out the main factor which may affect the observation of the intimal tear, these 35patients were then grouped based on three different scenarios, for instance, whether there wasthrombus in false lumen and the observational results of the intimal flap as well as the intimaltear, and then analyze the relationship among these three scenarios. In addition，a study on thecorrelation between the size of proximal intimal tear and the level of blood pressure was carriedout, and then following by the analysis on the relationship between the types of AD andhypertension. Finally, the study focused on different vascular invasion of both renal arteries,and discuss the possible causes.Results1. 35 patients all obtained satisfying images after the examination of computed tomographyangiography (CTA), which satisfies the diagnostic request based on cross-sectional imagesand the combination of several reconstruction techniques.III 汕头大学医学院硕士学位论文2. There is no statistical significance between the difference of the suffering rate ofhypertension in the patients with stanford type A aortic dissection or type B dissection.3. The observational results show high consistency of the size of true lumen and false lumen bymeasuring the area or the diameter (k=0.720, p=0.002).4. 28 patients whose proximal intimal tear were demonstrated clearly were then divided intotwo groups: firstly, the intensity of the true lumen was higher than the false lumen obviouslyin 17 patients，secondly, approximate intensity in the true lumen and false lumen was foundin 11 patients. Between the two groups, the average size of the proximal intimal tear in thefirst 17 patients group was smaller than the 11 patients group.5. No discrepancy was found in the demonstrated results of true lumen, false lumen, intimaltear and intimial flap by applying various reconstruction techniques, such as MPR, CPR, MIP
