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目的评价双源CT血管造影(DSCTA)综合评价Stanford A型主动脉夹层(AD)主动脉根部结构?冠状动脉和左心室功能的可行性。方法对36例Stanford A型AD患者行术前心电门控DSCTA扫描,评价冠状动脉、主动脉及主动脉瓣膜图像质量及受累情况,测量主动脉根部管径和左心室功能,计算辐射剂量。将DSCTA结果与手术所见进行比较。结果 35例患者成功完成DSCTA检查。97.14%(34/35)的胸主动脉和主动脉瓣膜图像、93.10%(445/478)的冠状动脉节段图像可用于诊断。右窦受累17例,无窦受累15例,左窦受累5例;右-无窦交界受累13例,左-右窦交界受累3例,左-无窦交界受累1例。主动脉窦部直径(41.6±9.4)mm;瓣环直径(28.2±4.1)mm;窦管交界直径(73.6±10.2)mm。左心室射血分数与主动脉根部受累程度呈负相关(r=-0.97,P=0.02)。平均有效辐射剂量为(21.96±4.36)mSv。DSCTA结果与手术病理诊断一致率(30/34,88.24%)和一致性(Kappa=0.82,P<0.01)均较高。结论 DSCTA“一站式”检查综合评价Stanford A型AD主动脉根部结构?冠状动脉和左心功能安全可靠。
Objective To evaluate the feasibility of dual-source CT angiography (DSCTA) in evaluating the aortic root structure, coronary artery and left ventricular function in patients with Stanford type A aortic dissection (AD). Methods Preoperative ECG-gated DSCTA scanning was performed on 36 patients with Stanford type A AD. The images of coronary artery, aorta and aortic valve were evaluated for image quality and involvement. The aortic root diameter and left ventricular function were measured to calculate the radiation dose. The DSCTA results were compared with the surgical findings. Results 35 patients successfully completed the DSCTA examination. In 97.14% (34/35) of thoracic aorta and aortic valve images, 93.10% (445/478) of coronary artery segment images were available for diagnosis. There were 17 cases of right sinus involvement, 15 cases of sinus involvement, 5 cases of left sinus involvement, 13 cases of right-no sinus junction involvement, 3 cases of left-right sinus junction involvement and 1 case of left-no sinus junction involvement. Aortic sinus diameter (41.6 ± 9.4) mm; annulus diameter (28.2 ± 4.1) mm; sinus junction diameter (73.6 ± 10.2) mm. Left ventricular ejection fraction was negatively correlated with the extent of aortic root involvement (r = -0.97, P = 0.02). The average effective radiation dose was (21.96 ± 4.36) mSv. The consistency between the results of DSCTA and the pathological diagnosis (30 / 34,88.24%) and consistency (Kappa = 0.82, P <0.01) were higher. Conclusion The DSCTA “one-stop ” examination is used for the comprehensive evaluation of the aortic root structure of Stanford type A coronary artery and left ventricular function is safe and reliable.