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动态容积CT血管造影术用于内漏的检测与分类:使用具有16厘米探测器的320排CT扫描仪的电影成像应用

Dynamic volumetric CT angiography for the detection and classification of endoleaks: application of cine imaging using a 320-row CT scanner with 16-cm detectors.

作者信息

Koike Yuya, Ishida Kazufumi, Hase Soichiro, Kobayashi Yasuyuki, Nishimura Jun-Ichi, Yamasaki Motoshige, Hosaka Norifumi

机构信息

Department of Interventional Radiology, Kawasaki Saiwai Hospital, 31-27, Omiya-Cho, Saiwai-Ku, Kawasaki, Kanagawa, 212-0014 Japan.

Department of Radiology, Kawasaki Saiwai Hospital, 31-27, Omiya-Cho, Saiwai-Ku, Kawasaki, Kanagawa, 212-0014 Japan.

出版信息

J Vasc Interv Radiol. 2014 Aug;25(8):1172-1180.e1. doi: 10.1016/j.jvir.2014.03.019. Epub 2014 May 14.

Abstract

PURPOSE

To assess the feasibility and diagnostic performance of dynamic volumetric computed tomography (CT) angiography with large-area detectors in the detection and classification of endoleaks after endovascular aneurysm repair (EVAR).

MATERIALS AND METHODS

Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position was used to scan the entire stent graft with a 16-cm-area detector during the first follow-up examination after EVAR. There were 39 consecutive patients (36 men and 3 women; mean age, 74 y ± 8.7) examined with approximately 14-20 intermittent scans (temporal resolution, 2 s; scan range, 160 mm). The effective radiation dose, image quality, interobserver and intraobserver agreement for endoleak detection, and time delay between peak enhancement of the aorta and endoleaks were evaluated.

RESULTS

All examinations with the patient in Fowler position enabled the entire stent graft to be scanned and were rated as diagnostic. The mean effective radiation dose was 13.1 mSv. Endoleaks were detected in eight patients (type Ia, n = 1; type II, n = 6; type III, n = 1). Interobserver agreement (κ = 0.794) and intraobserver agreement (κ = 1.00) for detection of endoleaks were excellent. The mean time delay between peak enhancement of the aorta and the endoleaks was significantly less for type I/III endoleaks (2.0 s ± 0) compared with type II endoleaks (5.3 s ± 1.0; P < .001).

CONCLUSIONS

Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position is feasible after EVAR. Dynamic information, including cine imaging, the timing of peak enhancement, and the Hounsfield units index, is useful in detecting and classifying endoleaks.

摘要

目的

评估采用大面积探测器的动态容积计算机断层扫描(CT)血管造影术在血管内动脉瘤修复术(EVAR)后内漏检测及分类中的可行性和诊断性能。

材料与方法

在EVAR后的首次随访检查中,让患者处于福勒体位,采用低剂量动态容积CT血管造影术,使用16厘米面积探测器对整个覆膜支架进行扫描。连续39例患者(36例男性和3例女性;平均年龄74岁±8.7岁)接受了约14 - 20次间歇性扫描(时间分辨率2秒;扫描范围160毫米)。评估了有效辐射剂量、图像质量、内漏检测的观察者间和观察者内一致性,以及主动脉峰值强化与内漏之间的时间延迟。

结果

所有患者处于福勒体位的检查均能对整个覆膜支架进行扫描,且被评为具有诊断价值。平均有效辐射剂量为13.1毫希沃特。8例患者检测到内漏(Ia型,n = 1;II型,n = 6;III型,n = 1)。内漏检测的观察者间一致性(κ = 0.794)和观察者内一致性(κ = 1.00)极佳。与II型内漏(5.3秒±1.0)相比,I/III型内漏在主动脉峰值强化与内漏之间的平均时间延迟明显更短(2.0秒±0;P < .001)。

结论

患者处于福勒体位的低剂量动态容积CT血管造影术在EVAR后是可行的。包括电影成像、峰值强化时间和亨氏单位指数在内的动态信息有助于内漏的检测和分类。

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