Rousseau H, Chabbert V, Maracher M A, El Aassar O, Auriol J, Massabuau P, Moreno R
Service de Radiologie, CHU Rangueil TSA 50032, 31059 Toulouse Cedex 9, France.
Eur J Vasc Endovasc Surg. 2009 Oct;38(4):408-21. doi: 10.1016/j.ejvs.2009.06.017. Epub 2009 Aug 4.
Indications for and experience with placement of endovascular stent grafts in the thoracic aorta are still evolving. Recent advances in imaging technologies have drastically boosted the role of pre-procedural imaging. The accepted diagnostic gold standard, digital subtraction angiography, is now being challenged by the state-of-the-art computed tomography angiography (CTA), magnetic resonance angiography (MRA) and trans-oesophageal echocardiography (TEE). Among these, technological advancements of multidetector computed tomography (MDCT) have propelled it to being the default modality used, optimising the balance between spatial and temporal resolutions and invasiveness. MDCT angiography allows the comprehensive evaluation of thoracic lesions in terms of morphological features and extent, presence of thrombus, relationship with adjacent structures and branches as well as signs of impending or acute rupture, and is routinely used in these settings. In this article, we review the current state-of-the-art radiological imaging for thoracic endovascular aneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. After analysing the technical aspects for optimised imaging protocols for thoracic aortic diseases, we discuss pre-procedural determinants of candidacy, and how to formulate interventional plans based on cross-sectional imaging.
胸主动脉腔内支架移植物置入的适应证及经验仍在不断发展。成像技术的最新进展极大地提升了术前成像的作用。公认的诊断金标准——数字减影血管造影，如今正受到先进的计算机断层扫描血管造影（CTA）、磁共振血管造影（MRA）和经食管超声心动图（TEE）的挑战。其中，多排螺旋计算机断层扫描（MDCT）的技术进步使其成为默认使用的检查方式，优化了空间和时间分辨率与侵入性之间的平衡。MDCT血管造影能够从形态特征和范围、血栓的存在、与相邻结构及分支的关系以及即将发生或急性破裂的征象等方面对胸段病变进行全面评估，并且在这些情况下常规使用。在本文中，我们回顾了胸主动脉腔内修复术（TEVAR）的当前先进放射学成像，尤其关注MDCT血管造影的作用。在分析了胸主动脉疾病优化成像方案的技术方面后，我们讨论了术前候选资格的决定因素，以及如何基于横断面成像制定介入计划。
