低剂量双源CT头颈主动脉联合扫描的可行性及在A型主动脉夹层的临床应用价值

doi:10.3969/j.issn.1674-1633.2017.11.003

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摘要目的分析急性A型主动脉夹层（Acute Type A Aortic Dissection，ATAAD）术前CT血管造影（CT Angiography， CTA）头颈主动脉联合扫描的可行性及临床价值。方法连续收集133例临床可疑ATAAD患者，接受头—盆腔CTA扫描。扫描参数：管电压80 kV，参考管电流300 mAs，开启自动管电流调控。记录每例患者容积CT剂量指数（CT Dose Index Volume，CTDIvol）及剂量长度乘积（Dose-Length Product，DLP）；对每例病例进行图像主观质量评分；评估与手术相关的头颈部血管CTA征象及颅内Willis环变异。结果经临床或CTA证实的ATAAD患者共123例。123例患者的平均CTDIvol 为（3.4±0.3）mGy；DLP为（314.1±29.3）mGy·cm。123例图像均满足诊断，图像质量计分为（1.18±0.40）分。头颈部CTA检出：夹层撕裂累及颈部血管58例（47.2%）、一侧颈动脉密度减低10例（8.1%）、颈动脉粥样硬化斑块15例（12.2%）、椎动脉发育不良12例（9.8%）、左椎动脉起自主动脉弓4例（3.3%）、右迷走锁骨下动脉3例（2.4%）、颅内动脉狭窄19例（15.5%）及颅内动脉瘤7例（5.7%）；与手术相关的颅内willis环解剖变异共检出57例（46.3%）。结论头颈主动脉联合扫描低辐射剂量CTA扫描是可行的。头颈部动脉的增量信息为临床手术治疗可提供重要依据。

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	赵宏亮^a
	郑敏文^a
	段维勋^b
	李剑^a
	石明国^a
	王晋^c

关键词 ：主动脉夹层, CT血管成像, 低辐射剂量, 颈部血管

Abstract：Objective To evaluate the low-dose dual-source head, neck and aorta CT angiography (CTA) in assessing the arteries of type A aortic dissection (ATAAD). Methods Low-dose head, neck and CTA were performed in 133 consecutive patients with suspected ATAAD. The volume CT dose index (CTDIvol) and dose-length product (DLP) were obtained for all scans. Subjective image quality of intracranial, cervical, thoracic and abdominal arteries were assessed. In addition, the surgery related CTA features as well as the Willis circle variations were recorded and analyzed. Results One hundred and twenty-three patients with definite diagnosis of ATAAD were enrolled in this study. Mean CTDIvol and DLP for all patients were (3.4±0.3) mGy and (314.1±29.3) mGy·cm. The detection rates of interlayer tearing involved in cervical artery (n=58), decreased lateral carotid artery density (n=10), carotid atherosclerotic plaque (n=15), dysplasia of vertebral artery (n=12), left vertebral artery with autonomic arterial arch (n=4), right vagus subclavian artery (n=3), intracranial arterial stenosis (n=19) and intracranial aneurysm (n=7) were 47.2%, 8.1%, 12.2%, 9.8%, 3.3%, 2.4%, 15.5% and 5.7% respectively. The Willis circle anatomic variation was found in 57 (46.3%) patients. Conclusion A combined CTA of head, neck and aorta in ATAAD is feasible. The incremental craniocervical information may lead to improved clinical outcomes.

Key words： aortic dissection CT angiography low-dose dual-source cervical vessels

收稿日期: 2017-08-10

R814.42

基金资助:国家重点研发计划（2016YFC1301900）；西京医院学科助推计划（XJZT14203）。

通讯作者: 王晋 E-mail: wangjinn@fmmu.edu.cn

作者简介:

引用本文:

赵宏亮^a，郑敏文^a，段维勋^b，李剑^a，石明国^a，王晋^c. 低剂量双源CT头颈主动脉联合扫描的可行性及在A型主动脉夹层的临床应用价值[J]. 中国医疗设备, 2017, 32(11): 8-11.
ZHAO Hongliang^a, ZHENG Minwen^a, DUAN Weixun^b, LI Jian^a, SHI Mingguo^a, WANG Jin^c. Clinical Application of Low-Dose Dual-Source of Cerebral and Carotid Arteries During Aortic CT Angiography in Type A Aortic Dissection. China Medical Devices, 2017, 32(11): 8-11.

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http://cs.china-cmd.org/zgylsb/CN/10.3969/j.issn.1674-1633.2017.11.003 或 http://cs.china-cmd.org/zgylsb/CN/Y2017/V32/I11/8

	after aortic repair for acute type A aortic dissection complicated
	by cerebral malperfusion: predictors and association with
[2]	邓宏平,陈蕾,王志维,等.单、双侧脑灌注技术在主动脉外科
[1]	Morimoto N,Okada K,Okita Y.Lack of neurologic improvement
	after aortic repair for acute type A aortic dissection complicated
	survival[J].J Thorac Cardiovasc Surg,2011,142(6):1540-1544.
[2]	邓宏平,陈蕾,王志维,等.单、双侧脑灌注技术在主动脉外科
	手术中脑保护效果的比较[J].武汉大学学报(医学版),2016,
37	(1):127-130.
37	(1):127-130.
[1]	Morimoto N,Okada K,Okita Y.Lack of neurologic improvement
	by cerebral malperfusion: predictors and association with
[2]	邓宏平,陈蕾,王志维,等.单、双侧脑灌注技术在主动脉外科
[1]	Morimoto N,Okada K,Okita Y.Lack of neurologic improvement
	by cerebral malperfusion: predictors and association with
	survival[J].J Thorac Cardiovasc Surg,2011,142(6):1540-1544.
	手术中脑保护效果的比较[J].武汉大学学报(医学版),2016,
	after aortic repair for acute type A aortic dissection complicated
	survival[J].J Thorac Cardiovasc Surg,2011,142(6):1540-1544.
	手术中脑保护效果的比较[J].武汉大学学报(医学版),2016,
37	(1):127-130.