Wang Gary X, Hedgire Sandeep S, Le Thang Q, Sonis Jonathan D, Yun Brian J, Lev Michael H, Raja Ali S, Prabhakar Anand M
Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Division of Cardiovascular Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Am J Emerg Med. 2017 Apr;35(4):527-530. doi: 10.1016/j.ajem.2016.11.039. Epub 2016 Nov 17.
Aortic dissection is typically evaluated with computed tomography angiography (CTA). However, the feasibility of using magnetic resonance angiography (MRA) in the ED is unclear. This study examined the indications and outcomes of MRA in suspected aortic dissection evaluation in the ED.
An IRB approved review identified patients who underwent MRA in the ED for acute thoracic aortic dissection from January 2010 to June 2016. Demographics, clinical assessment, CTA contraindications, outcomes, and ED disposition were analyzed.
50 MRAs were ordered for suspected thoracic aortic dissection. 21 (42%) for iodinated contrast allergy, 21 (42%) for renal insufficiency, 2 (4%) due to both, 2 (4%) to spare ionizing radiation, 2 (4%) for further work-up after CTA, and 2 (4%) due to prior contrast enhanced CT within 24h. Median ED arrival to MRA completion time was 311min. 42 studies were fully diagnostic; 7 were limited. One patient could not tolerate the examination. 49 MRAs were completed: 2 (4%) patients had acute dissection on MRA and 47 (96%) had negative exams. 17 (35%) received gadolinium. 18 (37%) patients were discharged home from the ED with a median length of stay of 643min. 2 (4%) were admitted for acute dissection seen on MRA and 29 (59%) for further evaluation.
MRA has a clear role in the evaluation for acute thoracic aortic dissection in the ED in patients with contraindications to CTA, and can guide management and facilitate safe discharge to home.
主动脉夹层通常采用计算机断层血管造影（CTA）进行评估。然而，在急诊科使用磁共振血管造影（MRA）的可行性尚不清楚。本研究探讨了MRA在急诊科疑似主动脉夹层评估中的适应证及结果。
一项经机构审查委员会（IRB）批准的回顾性研究，纳入了2010年1月至2016年6月期间在急诊科接受MRA检查以诊断急性胸主动脉夹层的患者。分析患者的人口统计学资料、临床评估、CTA禁忌证、检查结果及急诊科处理情况。
共对50例疑似胸主动脉夹层患者进行了MRA检查。其中，21例（42%）因对碘造影剂过敏，21例（42%）因肾功能不全，2例（4%）因两者兼有，2例（4%）为避免电离辐射，2例（4%）在CTA检查后需进一步检查，2例（4%）因在24小时内曾接受过增强CT检查。从患者抵达急诊科至MRA检查完成的中位时间为311分钟。42项检查结果为完全诊断性；7项检查结果受限。1例患者无法耐受检查。共完成49例MRA检查：2例（4%）患者MRA检查显示急性夹层，47例（96%）检查结果为阴性。17例（35%）接受了钆对比剂检查。18例（37%）患者从急诊科出院回家，中位住院时间为643分钟。2例（4%）因MRA检查发现急性夹层而入院，29例（59%）因需进一步评估而入院。
对于有CTA禁忌证且在急诊科疑似急性胸主动脉夹层的患者，MRA在评估中具有明确作用，可指导治疗并有助于安全出院回家。
