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目的探讨128层螺旋CT血管成像及后处理技术在主动脉夹层(aortic dissection,AD)诊断中的价值。方法疑诊AD患者78例,均行128层螺旋CT血管成像检查,进行容积再现技术(volume rendering technique,VRT)、自由切割成像、多平面重组(multiplanar reformation,MPR)、曲面重建(curved planar reformation,CPR)及最大密度投影(maximum intensity projection,MIP)等后处理。对AD患者行Stanford分型和DeBakey分型,比较动静脉期AD真假腔CT值,及后处理技术对AD内膜破口的显示率。结果 128层螺旋CT血管成像检出AD患者59例,Stanford分型A型21例、B型38例,DeBakey分型Ⅰ型13例、Ⅱ型8例、Ⅲ型38例;动脉期时AD真腔CT值[(257.37±51.79)Hu]高于假腔[(225.76±50.26)Hu],静脉期时AD真腔CT值[(157.39±59.56)Hu]低于假腔[(164.54±57.35)Hu],差异均有统计学意义(P<0.05);自由切割成像+轴位对内膜初始破口的显示率为93.22%、自由切割成像为89.83%、CPR为83.05%、MPR为81.36%、轴位为76.27%,明显高于VRT(35.59%)和MIP(13.56%),差异有统计学意义(P<0.05)。结论 128层螺旋CT血管成像是术前诊断AD及对AD作出准确分型的可靠影像学检查方法,但其不同后处理技术各有优缺点,对内膜初始破口的显示率不同。
Objective To investigate the value of 128-slice spiral CT angiography and postprocessing in the diagnosis of aortic dissection (AD). Methods Totally 78 patients with suspected AD were examined with 128-slice spiral CT angiography. VRT, free-cut imaging, multiplanar reformation (MPR) and curved planar reformation , CPR) and maximum intensity projection (MIP). Stanford classification and DeBakey classification of AD patients were performed. The CT values of the true and false cavities in arteriovenous phase were compared, and the display rate of post-processing technique on the intimal tear was compared. Results Fifty-nine patients with AD in Stanford type A, 21 patients in Stanford type A, 38 patients in type B, 13 in type I in DeBakey, 8 in type II and 38 in type III were detected by 128-slice spiral CT angiography. The value of CT in the cavity was higher than that in the false cavity [(225.76 ± 50.26) Hu], and the value of [(157.39 ± 59.56) Hu] in the true cavity of the AD in the vein was lower than that in the false lumen [(164.54 ± 57.35) (P <0.05). The rate of free incision imaging and axial incision was 93.22%, the free-cutting imaging was 89.83%, the CPR was 83.05%, the MPR was 81.36%, the difference was statistically significant , The axial position was 76.27%, significantly higher than VRT (35.59%) and MIP (13.56%), the difference was statistically significant (P <0.05). Conclusions 128-slice spiral CT angiography is a reliable imaging method for preoperative diagnosis of AD and accurate classification of AD. However, the different post-processing techniques have their own advantages and disadvantages, and the display rate of initial rupture of endometrium is different.