Sasaki S, Yoshida H, Matsui Y, Sakuma M, Yasuda K, Tanade T
Kyobu Geka. 1989 Apr;42(4):297-302.
The value of non-invasive medical imagings in diagnosis of dissecting aortic aneurysm was evaluated in 23 patients by two-dimensional transesophageal echocardiography (TEE) and in 23 patients by MRI. An intimal flap was demonstrated in all 23 cases by TEE and in 21 of 23 cases (91.3%) by MRI. DeBakey type classification could be recognized in 20 of 23 cases (87.0%) by TEE and in 21 of 23 cases (91.3%) by MRI. The entry of aortic dissection could be identified in 20 of 23 cases (87.0%) by TEE in 9 of 23 cases (39.1%) by MRI. The differentiation between true and false lumen could be performed in all 23 cases by TEE and in 21 of 23 cases (91.3%) by MRI. The capability of TEE to visualize the lesion of descending aorta was superior to any other conventional diagnostic method, however, there were difficulties in scanning the distal part of the ascending aorta and aortic arch. MRI could not detect the small lesion such as entry in almost all cases, but was superior in diagnosis of the lesion of aortic arch and in recognition of the whole imagings. Since transthoracic echocardiography has an additional value in diagnosis of dissecting aortic aneurysm, the diagnostic method of a combination of transthoracic and transesophageal echocardiography seems to be more valuable. We believe that operation could be carried out solely on the basis of diagnosis of dissecting aortic aneurysm by echocardiography in emergency cases.
对23例患者采用二维经食管超声心动图（TEE）评估无创医学成像在主动脉夹层动脉瘤诊断中的价值，对另外23例患者采用磁共振成像（MRI）进行评估。TEE检查的23例患者均显示有内膜瓣，MRI检查的23例患者中有21例（91.3%）显示有内膜瓣。TEE检查的23例患者中有20例（87.0%）可识别DeBakey分型，MRI检查的23例患者中有21例（91.3%）可识别。TEE检查的23例患者中有20例（87.0%）可确定主动脉夹层的入口，MRI检查的23例患者中有9例（39.1%）可确定。TEE检查的所有23例患者均可区分真腔和假腔，MRI检查的23例患者中有21例（91.3%）可区分。TEE显示降主动脉病变的能力优于任何其他传统诊断方法，然而，扫描升主动脉远端和主动脉弓存在困难。MRI在几乎所有病例中均无法检测到如入口处这样的小病变，但在主动脉弓病变的诊断以及整体成像的识别方面更具优势。由于经胸超声心动图在主动脉夹层动脉瘤诊断中具有额外价值，经胸和经食管超声心动图联合诊断方法似乎更有价值。我们认为在紧急情况下，仅根据超声心动图对主动脉夹层动脉瘤的诊断即可进行手术。
