Imaging Institute, Cleveland Clinic, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Imaging. 2017 May;10(5):554-561. doi: 10.1016/j.jcmg.2016.04.010. Epub 2016 Sep 21.
This study sought to evaluate the diagnostic yield of a dedicated computed tomography angiography (CTA) protocol of the chest, abdomen, and pelvis in patients with fibromuscular dysplasia (FMD).
FMD is an uncommon vascular disease that may result in stenosis, dissection, or aneurysm of nearly all arterial distributions, typically affecting medium-sized arteries. Findings from the United States Registry for Fibromuscular Dysplasia have suggested the potential need to perform screening imaging of the aorta and medium branch vessels.
A total of 113 consecutive patients enrolled in our institutional FMD registry who received a tailored CTA protocol at our institution between March 2013 and June 2015 were included in this study. Arterial phase contrast-enhanced images were obtained on a dual-source scanner using high pitch and electrocardiogram trigger. Images were analyzed by 2 readers.
Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, and iliac distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, 1 with mild dilation (4.4 cm). Incremental findings beyond those known at patient intake were commonly noted, including new areas of arterial beading (n = 55 [49%]), new aneurysms (n = 21 [19%]), and new dissections (n = 3 [3%]). Reformatted images were crucial, affecting final assessment in 56% of cases evaluated by reader 1 and 36% evaluated by reader 2.
Screening chest, abdomen, and pelvis CTA in patients with FMD showed substantial and incremental diagnostic yield. Reformatted images should routinely be included in imaging analysis. Abnormalities in the aorta were not common, so screening of the thoracic aorta may not be indicated.
本研究旨在评估专门的胸部、腹部和骨盆 CT 血管造影（CTA）方案在纤维肌发育不良（FMD）患者中的诊断效果。
FMD 是一种罕见的血管疾病，可能导致几乎所有动脉分布的狭窄、夹层或动脉瘤，通常影响中等大小的动脉。美国纤维肌发育不良注册研究的结果表明，可能需要对主动脉和中等分支血管进行筛查成像。
本研究共纳入 113 例连续患者，这些患者于 2013 年 3 月至 2015 年 6 月在我院接受了定制的 CTA 方案，并在我院进行了该方案。使用高斜率和心电图触发，在双源扫描仪上获取动脉期对比增强图像。由 2 位读者分析图像。
主动脉、肾、肠系膜和髂分布中可见异常，包括珠状、动脉瘤、夹层和狭窄/闭塞。最常受影响的血管是肾动脉（n=76[67%]），其次是下肢/髂动脉（n=37[32%]）。主动脉异常较少见（n=3[3%]），包括 1 例升主动脉轻度扩张（4.2cm）和 2 例降主动脉夹层，其中 1 例伴有轻度扩张（4.4cm）。在患者就诊时已知的基础上，经常发现新的动脉珠状（n=55[49%]）、新的动脉瘤（n=21[19%]）和新的夹层（n=3[3%]）等额外发现。读者 1 评估的 56%病例和读者 2 评估的 36%病例中，重建成像至关重要，影响最终评估。
对 FMD 患者进行胸部、腹部和骨盆 CTA 筛查显示出大量且递增的诊断效果。成像分析应常规包括重建成像。主动脉异常不常见，因此可能不需要对胸主动脉进行筛查。
