多層螺旋CT血管成像在主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后內(nèi)漏中的價(jià)值探討
發(fā)布時(shí)間：2018-08-22 07:37
【摘要】：第一部分多層螺旋CT血管成像和彩色多普勒超聲檢查在主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后內(nèi)漏檢測(cè)的對(duì)比研究目的:比較主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后1月隨訪患者同時(shí)行多層螺旋CT血管成像和彩色多普勒超聲檢查對(duì)內(nèi)漏的檢測(cè)。材料與方法:收集四川省人民醫(yī)院2014年1月1日至2016年10月31日共34例主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后1月的隨訪患者進(jìn)行回顧性分析,年齡范圍38歲-81歲,平均年齡55.91±11.80歲,其中男性25例(73.5%),女性9例(26.5%)。所有患者在腔內(nèi)支架隔絕術(shù)后1月(平均時(shí)間29±6天)同時(shí)行多層螺旋CT血管成像和彩色多普勒超聲檢查,兩種檢查間隔時(shí)間不超過1周。CT圖像及超聲檢查圖像各由2名經(jīng)驗(yàn)豐富的高年資醫(yī)師組成閱片小組進(jìn)行評(píng)估,評(píng)估前互不知道另一種檢查方法的結(jié)果。以多層螺旋CT血管成像檢查結(jié)果作為術(shù)后內(nèi)漏檢測(cè)的金標(biāo)準(zhǔn),獲得彩色多普勒超聲檢測(cè)內(nèi)漏的真陽(yáng)性率、假陽(yáng)性率、假陰性率、敏感性、特異性、準(zhǔn)確性、陰性預(yù)測(cè)值、陽(yáng)性預(yù)測(cè)值。數(shù)據(jù)分析采用配對(duì)χ2檢驗(yàn),p0.05為差異有統(tǒng)計(jì)學(xué)意義。Kappa指數(shù)進(jìn)一步評(píng)估多層螺旋CT血管成像和彩色多普勒超聲檢測(cè)內(nèi)漏的一致性。結(jié)果:多層螺旋CT檢測(cè)出11例內(nèi)漏,內(nèi)漏發(fā)生率32.4%,其中I型內(nèi)漏10例(29.4%),III型內(nèi)漏1例(2.9%),無(wú)II型內(nèi)漏。10例I型內(nèi)漏中,5例出現(xiàn)在支架近端(Ia型),3例出現(xiàn)在支架遠(yuǎn)端(Ib型),2例在支架近、遠(yuǎn)端均可見(Ia、Ib型)。彩色多普勒超聲檢測(cè)出8例內(nèi)漏,均為I型,其中5例內(nèi)漏位于支架近端(Ia型),2例位于支架遠(yuǎn)端(Ib型),1例于支架近、遠(yuǎn)端均可查及(Ia、Ib型);8例內(nèi)漏中,6例與多層螺旋CT血管成像檢查結(jié)果一致,2例彩色多普勒超聲顯示陽(yáng)性而多層螺旋CT為陰性。MS-CTA檢出1例III型內(nèi)漏而彩色多普勒超聲顯示為陰性。與多層螺旋CT血管成像相比,彩色多普勒超聲對(duì)內(nèi)漏檢測(cè)的真陽(yáng)性率54.5%(6/11),假陽(yáng)性率8.7%(2/23),假陰性率為45.4%(5/11),敏感性54.5%(6/11),特異性91.3(21/23),準(zhǔn)確性79.4%(27/34),陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為75%(6/8)和80.8%(21/26)。兩種檢查方法的一致性中等(k=0.494)。34例主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后1月隨訪患者植入支架均未發(fā)生斷裂、解體、移位及變形,所有患者假腔內(nèi)均有不同程度血栓形成,支架覆蓋區(qū)真腔血流均通暢,34例患者支架內(nèi)膜下均未見附壁血栓形成。因6例外院治療患者術(shù)前影像資料缺乏,余28例術(shù)前影像資料完善患者,術(shù)后多層螺旋CT圖像顯示其夾層動(dòng)脈瘤瘤體均未見繼續(xù)擴(kuò)大,真腔壓迫減輕,形態(tài)得以不同程度恢復(fù)。結(jié)論:多層螺旋CT和彩色多普勒超聲都能對(duì)主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后內(nèi)漏進(jìn)行隨訪�？紤]到放射累積劑量及花費(fèi),彩色多普勒超聲可對(duì)內(nèi)漏進(jìn)行初步篩查,但其敏感性及陽(yáng)性預(yù)測(cè)值較低。多層螺旋CT血管成像仍作為內(nèi)漏隨訪主要的影像學(xué)檢查方法。第二部分術(shù)前多層螺旋CT影像特征參數(shù)預(yù)測(cè)Standford B型主動(dòng)脈夾層腔內(nèi)隔絕術(shù)后1月I型內(nèi)漏的研究目的:本研究旨在分析術(shù)前多層螺旋CT血管造影檢查的影像特征參數(shù),探討不同特征參數(shù)對(duì)Standford B型主動(dòng)脈夾層腔內(nèi)隔絕術(shù)后I型內(nèi)漏有無(wú)預(yù)測(cè)價(jià)值。材料與方法:收集四川省人民醫(yī)院2014年1月1日至2016年10月31日共26例Standford B型主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后1月行多層螺旋CT隨訪患者,對(duì)患者術(shù)前多層螺旋CT血管造影檢查的影像參數(shù)進(jìn)行回顧性分析。26例患者年齡范圍40-81歲,平均年齡58.88±11.28歲,其中男性18例(69.23%),女性8例(30.77%)。術(shù)前首次行胸腹部MS-CTA檢查的時(shí)間距離手術(shù)1-22天。所有患者術(shù)后1月行多層螺旋CT血管造影檢查,根據(jù)檢出有、無(wú)內(nèi)漏,將患者分為內(nèi)漏組(LG:術(shù)后1月MS-CTA檢查發(fā)現(xiàn)內(nèi)漏;n=10例)和無(wú)內(nèi)漏組(NLG:術(shù)后1月MS-CTA檢查未發(fā)現(xiàn)內(nèi)漏;n=16例)。術(shù)前MS-CTA影像特征參數(shù)包括:初始破口寬度,近端破口層面、瘤體最大橫徑層面、左鎖骨下動(dòng)脈開口層面、氣管隆突分叉層面、膈肌層面、膈肌至腹腔干區(qū)瘤體最大橫徑層面、腹腔干至腎動(dòng)脈區(qū)瘤體最大橫徑層面、腎動(dòng)脈至髂血管分叉區(qū)瘤體最大橫徑層面的真腔直徑、假腔直徑、主動(dòng)脈直徑及各層面真腔比(T/A:該層面真腔直徑與主動(dòng)脈直徑的比值)、假腔比(F/A:該層面假腔直徑與主動(dòng)脈直徑的比值)、真假腔比值(T/F:該層面真腔直徑與假腔直徑的比值),主動(dòng)脈壁鈣化,假腔血栓,支架近端主動(dòng)脈壁鈣化及該區(qū)假腔血栓,支架遠(yuǎn)端主動(dòng)脈壁鈣化及該區(qū)假腔血栓,腹腔干至腎動(dòng)脈區(qū)主動(dòng)脈壁鈣化及該區(qū)假腔血栓情況。所有患者術(shù)前MS-CTA圖像及腔內(nèi)支架隔絕術(shù)后1月隨訪的MS-CTA圖像均由2名經(jīng)驗(yàn)豐富的高年資醫(yī)師組成閱片小組分析影像特征及測(cè)量有關(guān)數(shù)據(jù),且分析術(shù)前MS-CTA圖像時(shí)并不知曉術(shù)后1月MS-CTA隨訪結(jié)果。數(shù)據(jù)分析采用獨(dú)立樣本t檢驗(yàn),Fisher確切概率法,使用受試工作者曲線(ROC曲線)下面積確定術(shù)前MS-CTA特征性參數(shù)的最佳臨界值,并計(jì)算敏感度、特異度,以p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:26例Standford B型主動(dòng)脈夾層EVGE術(shù)后1月行MS-CTA檢查,檢出無(wú)內(nèi)漏患者16例,內(nèi)漏患者10例,所有內(nèi)漏均為I型,5例出現(xiàn)在支架近端(Ia型),3例出現(xiàn)在支架遠(yuǎn)端(Ib型),2例在支架近、遠(yuǎn)端均可見(Ia、Ib型),無(wú)II型內(nèi)漏。術(shù)前MS-CTA特征性參數(shù)評(píng)估中:腹腔干至腎動(dòng)脈瘤體區(qū)最大橫徑平面真假腔比值(T/F)在兩組間有統(tǒng)計(jì)學(xué)差異(內(nèi)漏組:1.11±0.50cm;無(wú)內(nèi)漏組:0.67±0.41;p=0.04;ROC曲線下面積=0.77,最佳臨界點(diǎn)cutoff值為0.68,敏感性75%,特異性83.3%)。內(nèi)漏組和無(wú)內(nèi)漏組在近端破口層面、瘤體最大橫徑層面、氣管隆突分叉層面、膈肌層面、膈肌至腹腔干區(qū)瘤體最大橫徑層面、腎動(dòng)脈至髂血管分叉區(qū)瘤體最大橫徑層面的真腔直徑、假腔直徑、主動(dòng)脈直徑及上述各層面真腔比(T/A)、假腔比(F/A)、真假腔比值(T/F)均無(wú)統(tǒng)計(jì)學(xué)差異;在左鎖骨下動(dòng)脈開口層面主動(dòng)脈直徑無(wú)統(tǒng)計(jì)學(xué)差異;在腹腔干至腎動(dòng)脈區(qū)瘤體最大橫徑層面真腔直徑、假腔直徑、主動(dòng)脈直徑、真腔比(T/A)、假腔比(F/A)無(wú)統(tǒng)計(jì)學(xué)差異;兩組間在初始破口寬度,主動(dòng)脈壁鈣化,假腔血栓,支架近端主動(dòng)脈壁鈣化及該區(qū)假腔血栓,支架遠(yuǎn)端主動(dòng)脈壁鈣化及該區(qū)假腔血栓,腹腔干至腎動(dòng)脈區(qū)主動(dòng)脈壁鈣化及該區(qū)假腔血栓均無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論:術(shù)前多層螺旋CT血管成像檢查圖像上腹腔干至腎動(dòng)脈區(qū)瘤體最大橫徑層面真腔與假腔的比值(T/F)可預(yù)測(cè)Standford B型主動(dòng)脈夾層腔內(nèi)支架隔絕術(shù)后1月I型內(nèi)漏的發(fā)生。
[Abstract]:The first part is a comparative study of multi-slice spiral CT angiography and color Doppler ultrasonography in detecting endoleak after stent exclusion in aortic dissection. Methods: A retrospective analysis was made on 34 patients with dissecting aorta who were followed up for 1 month from January 1, 2014 to October 31, 2016 in Sichuan People's Hospital. The age ranged from 38 to 81 years, with an average age of 55.91 [11.80], including 25 males (73.5%) and 9 females (26.5%). The mean time was 29 As the gold standard of postoperative endoleak detection, the true positive rate, false positive rate, false negative rate, sensitivity, specificity, accuracy, negative predictive value and positive predictive value of color Doppler ultrasound were obtained. Results: 11 cases of endoleak were detected by multi-slice spiral CT, and the rate of endoleak was 32.4%. Among them, 10 cases (29.4%) were type I, 1 case (2.9%) was type III and 1 case (2.9%) had no type II endoleak. Color Doppler ultrasonography detected 8 cases of endoleaks, all type I, including 5 cases in the proximal end of the stent (type Ia), 2 cases in the distal end of the stent (type Ib), 1 case in the proximal end of the stent (type Ia, type Ib), and 1 case in the distal end of the stent (type Ia, type Ib). Compared with multi-slice spiral CT angiography, the true positive rate, false positive rate, false negative rate, sensitivity, specificity and accuracy of color Doppler ultrasonography were 54.5% (6/11), 8.7% (2/23), 45.4% (5/11), 54.5% (6/11), 91.3 (21/23), respectively. Sex 79.4% (27/34), positive predictive value and negative predictive value were 75% (6/8) and 80.8% (21/26), respectively. The consistency of the two methods was moderate (k = 0.494). 34 patients with aortic dissection were followed up for 1 month without stent rupture, disintegration, displacement and deformation. All patients had different degrees of thrombosis and branches in the false lumen. True lumen blood flow was smooth in the covered area of the stent, and no mural thrombosis was found in 34 patients under the stent. Because of the lack of preoperative imaging data in 6 patients and the improvement of preoperative imaging data in the remaining 28 patients, multislice spiral CT images showed that the dissecting aneurysms were not enlarged, the true lumen compression was relieved, and the shape of the dissecting aneurysms to varying degrees. Conclusion: Multislice spiral CT and color Doppler ultrasonography can be used for follow-up of endoleak after endovascular stent exclusion in aortic dissection. Considering the cumulative dose and cost of radiation, color Doppler ultrasonography can be used for preliminary screening of endoleak, but its sensitivity and positive predictive value are low. The second part is the study of predicting type I leak in patients with Standford type B aortic dissection after endovascular graft exclusion by preoperative multi-slice spiral CT imaging characteristic parameters. The purpose of this study was to analyze the imaging characteristic parameters of preoperative multi-slice spiral CT angiography and to explore the effect of different characteristic parameters on Standford type B aortic dissection. Materials and Methods: From January 1, 2014 to October 31, 2016, 26 patients with Standford B type aortic dissection underwent multislice spiral CT follow-up one month after endovascular stent exclusion in Sichuan Provincial People's Hospital. The imaging parameters of preoperative multislice spiral CT angiography were retrospectively analyzed. The mean age of 26 patients ranged from 40 to 81 years, with an average age of 58.88 (+ 11.28 years). 18 males (69.23%) and 8 females (30.77%). The first time of MS-CTA examination was 1-22 days after operation. All patients underwent multi-slice spiral CT angiography one month after operation. According to the presence or absence of endorrhea, the patients were divided into endorrhea group (LG: 1 month after operation). MS-CTA revealed endoleak; n = 10 cases) and no endoleak (NLG: No endoleak was found in MS-CTA at 1 month postoperatively; n = 16 cases). The preoperative imaging features of MS-CTA included: initial rupture width, proximal rupture level, maximum transverse diameter level, left subclavian artery opening level, tracheal eminence bifurcation level, diaphragm level, diaphragm to abdominal trunk area, the most common tumor. On the large transverse plane, from the abdominal trunk to the largest transverse plane of the aneurysm, from the renal artery to the bifurcation of the iliac artery, the true lumen diameter, the false lumen diameter, the aortic diameter and the true lumen ratio (T/A: the ratio of the true lumen diameter to the aortic diameter) and the false lumen ratio (F/A: the ratio of the false lumen diameter to the aortic diameter in this plane) Value, true to false lumen ratio (T/F: ratio of true to false lumen diameter at this level), aortic wall calcification, false lumen thrombosis, proximal aortic wall calcification of stent and false lumen thrombosis in this area, distal aortic wall calcification of stent and false lumen thrombosis in this area, abdominal trunk to renal artery wall calcification and false lumen thrombosis in this area. Both CTA images and MS-CTA images of 1-month follow-up after endovascular stent exclusion were analyzed by a group of two experienced senior physicians. The preoperative MS-CTA images were analyzed without knowing the results of 1-month follow-up. Data were analyzed by independent sample t test, Fisher exact probability method, and received. Results: Twenty-six patients with Standford B type aortic dissection underwent MS-CTA examination one month after EVGE. There were 16 patients without endoleak, 10 patients with endoleak, all of which were type I and 5 patients with endoleak. In the preoperative evaluation of MS-CTA characteristic parameters, the ratio of true to false lumen (T/F) from abdominal trunk to renal artery aneurysm was significantly different between the two groups (endoleak group: 1.11 + 0.50 cm; no endoleak group: 0.67 + 0.50 cm). The cutoff value of the best critical point was 0.68, sensitivity 75%, specificity 83.3%. There was no significant difference in the true lumen diameter, false lumen diameter, aortic diameter, true lumen ratio (T/A), false lumen ratio (F/A) and true to false lumen ratio (T/F) between the two layers; there was no significant difference in the aortic diameter at the left subclavian artery opening level; there was no significant difference in the true lumen diameter, false lumen diameter, aortic diameter at the maximum transverse dimension from the celiac trunk to the renal artery region. There was no significant difference between the two groups in the initial rupture width, aortic wall calcification, false lumen thrombosis, proximal aortic wall calcification and false lumen thrombosis, distal aortic wall calcification and false lumen thrombosis, abdominal trunk to renal artery calcification and false lumen thrombosis. Conclusion: The ratio of true to false lumen (T/F) at the maximum transverse dimension from the celiac trunk to the renal artery on preoperative multi-slice spiral CT angiography can predict the occurrence of type I endoleak after endovascular stent exclusion for Standford type B aortic dissection.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.3;R816.2
本文編號(hào)：2196431
[Abstract]:The first part is a comparative study of multi-slice spiral CT angiography and color Doppler ultrasonography in detecting endoleak after stent exclusion in aortic dissection. Methods: A retrospective analysis was made on 34 patients with dissecting aorta who were followed up for 1 month from January 1, 2014 to October 31, 2016 in Sichuan People's Hospital. The age ranged from 38 to 81 years, with an average age of 55.91 [11.80], including 25 males (73.5%) and 9 females (26.5%). The mean time was 29 As the gold standard of postoperative endoleak detection, the true positive rate, false positive rate, false negative rate, sensitivity, specificity, accuracy, negative predictive value and positive predictive value of color Doppler ultrasound were obtained. Results: 11 cases of endoleak were detected by multi-slice spiral CT, and the rate of endoleak was 32.4%. Among them, 10 cases (29.4%) were type I, 1 case (2.9%) was type III and 1 case (2.9%) had no type II endoleak. Color Doppler ultrasonography detected 8 cases of endoleaks, all type I, including 5 cases in the proximal end of the stent (type Ia), 2 cases in the distal end of the stent (type Ib), 1 case in the proximal end of the stent (type Ia, type Ib), and 1 case in the distal end of the stent (type Ia, type Ib). Compared with multi-slice spiral CT angiography, the true positive rate, false positive rate, false negative rate, sensitivity, specificity and accuracy of color Doppler ultrasonography were 54.5% (6/11), 8.7% (2/23), 45.4% (5/11), 54.5% (6/11), 91.3 (21/23), respectively. Sex 79.4% (27/34), positive predictive value and negative predictive value were 75% (6/8) and 80.8% (21/26), respectively. The consistency of the two methods was moderate (k = 0.494). 34 patients with aortic dissection were followed up for 1 month without stent rupture, disintegration, displacement and deformation. All patients had different degrees of thrombosis and branches in the false lumen. True lumen blood flow was smooth in the covered area of the stent, and no mural thrombosis was found in 34 patients under the stent. Because of the lack of preoperative imaging data in 6 patients and the improvement of preoperative imaging data in the remaining 28 patients, multislice spiral CT images showed that the dissecting aneurysms were not enlarged, the true lumen compression was relieved, and the shape of the dissecting aneurysms to varying degrees. Conclusion: Multislice spiral CT and color Doppler ultrasonography can be used for follow-up of endoleak after endovascular stent exclusion in aortic dissection. Considering the cumulative dose and cost of radiation, color Doppler ultrasonography can be used for preliminary screening of endoleak, but its sensitivity and positive predictive value are low. The second part is the study of predicting type I leak in patients with Standford type B aortic dissection after endovascular graft exclusion by preoperative multi-slice spiral CT imaging characteristic parameters. The purpose of this study was to analyze the imaging characteristic parameters of preoperative multi-slice spiral CT angiography and to explore the effect of different characteristic parameters on Standford type B aortic dissection. Materials and Methods: From January 1, 2014 to October 31, 2016, 26 patients with Standford B type aortic dissection underwent multislice spiral CT follow-up one month after endovascular stent exclusion in Sichuan Provincial People's Hospital. The imaging parameters of preoperative multislice spiral CT angiography were retrospectively analyzed. The mean age of 26 patients ranged from 40 to 81 years, with an average age of 58.88 (+ 11.28 years). 18 males (69.23%) and 8 females (30.77%). The first time of MS-CTA examination was 1-22 days after operation. All patients underwent multi-slice spiral CT angiography one month after operation. According to the presence or absence of endorrhea, the patients were divided into endorrhea group (LG: 1 month after operation). MS-CTA revealed endoleak; n = 10 cases) and no endoleak (NLG: No endoleak was found in MS-CTA at 1 month postoperatively; n = 16 cases). The preoperative imaging features of MS-CTA included: initial rupture width, proximal rupture level, maximum transverse diameter level, left subclavian artery opening level, tracheal eminence bifurcation level, diaphragm level, diaphragm to abdominal trunk area, the most common tumor. On the large transverse plane, from the abdominal trunk to the largest transverse plane of the aneurysm, from the renal artery to the bifurcation of the iliac artery, the true lumen diameter, the false lumen diameter, the aortic diameter and the true lumen ratio (T/A: the ratio of the true lumen diameter to the aortic diameter) and the false lumen ratio (F/A: the ratio of the false lumen diameter to the aortic diameter in this plane) Value, true to false lumen ratio (T/F: ratio of true to false lumen diameter at this level), aortic wall calcification, false lumen thrombosis, proximal aortic wall calcification of stent and false lumen thrombosis in this area, distal aortic wall calcification of stent and false lumen thrombosis in this area, abdominal trunk to renal artery wall calcification and false lumen thrombosis in this area. Both CTA images and MS-CTA images of 1-month follow-up after endovascular stent exclusion were analyzed by a group of two experienced senior physicians. The preoperative MS-CTA images were analyzed without knowing the results of 1-month follow-up. Data were analyzed by independent sample t test, Fisher exact probability method, and received. Results: Twenty-six patients with Standford B type aortic dissection underwent MS-CTA examination one month after EVGE. There were 16 patients without endoleak, 10 patients with endoleak, all of which were type I and 5 patients with endoleak. In the preoperative evaluation of MS-CTA characteristic parameters, the ratio of true to false lumen (T/F) from abdominal trunk to renal artery aneurysm was significantly different between the two groups (endoleak group: 1.11 + 0.50 cm; no endoleak group: 0.67 + 0.50 cm). The cutoff value of the best critical point was 0.68, sensitivity 75%, specificity 83.3%. There was no significant difference in the true lumen diameter, false lumen diameter, aortic diameter, true lumen ratio (T/A), false lumen ratio (F/A) and true to false lumen ratio (T/F) between the two layers; there was no significant difference in the aortic diameter at the left subclavian artery opening level; there was no significant difference in the true lumen diameter, false lumen diameter, aortic diameter at the maximum transverse dimension from the celiac trunk to the renal artery region. There was no significant difference between the two groups in the initial rupture width, aortic wall calcification, false lumen thrombosis, proximal aortic wall calcification and false lumen thrombosis, distal aortic wall calcification and false lumen thrombosis, abdominal trunk to renal artery calcification and false lumen thrombosis. Conclusion: The ratio of true to false lumen (T/F) at the maximum transverse dimension from the celiac trunk to the renal artery on preoperative multi-slice spiral CT angiography can predict the occurrence of type I endoleak after endovascular stent exclusion for Standford type B aortic dissection.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.3;R816.2
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