Yamaguchi Shoko, Murakami Hironori, Kudo Tomoko, Otokozawa Chiharu, Sasaki Shunsuke, Yuda Satoshi, Nojima Masanori
Department of Clinical Laboratory Medicine, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan.
Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan.
J Echocardiogr. 2017 Sep;15(3):127-134. doi: 10.1007/s12574-017-0331-y. Epub 2017 Feb 10.
Transthoracic echocardiography (TTE) is not recommended as the first-line diagnostic modality for Stanford type B aortic dissection (type-B AD).
The aims of this study were to evaluate the usefulness and factors influencing for the diagnosis of type-B AD using the transthoracic echocardiographic paravertebral approach (PVA).
We compared the image acquisition rate of descending thoracic aorta (DTA) and the diagnostic rate of type-B AD using TTE versus PVA. Both tests were compared with type-B AD, which was diagnosed by enhanced computed tomography (CT), as the reference standard. We also analyzed the factors influencing adequate image acquisition and the diagnosis of type-B AD using the PVA. The length between the dorsal thoracic surface and the DTA (TDAL) and thickness of lung on the TDAL line (LTh) were measured on the CT images.
No significant difference was found between the image acquisition rate of the DTA between the PVA and the TTE (70.1 vs. 64.2%, p = 0.56), while the diagnostic rate of type-B AD using the PVA was significantly greater than when using the TTE (56.7 vs. 26.9%, p < 0.001). Furthermore, when adequate images of DTA were obtained using the PVA, 80.9% of the patients were diagnosed with type-B AD. A multivariate analysis demonstrated that a lower LTh (p = 0.001) and the existence of a pleural effusion (p = 0.03) significantly influenced the diagnosis of type-B AD using the PVA.
The PVA might be a useful method for diagnosis of type-B AD, when adequate images of the DTA are obtained.
经胸超声心动图（TTE）不被推荐作为斯坦福B型主动脉夹层（B型AD）的一线诊断方式。
本研究旨在评估经胸超声心动图椎旁入路（PVA）对B型AD诊断的有效性及影响因素。
我们比较了使用TTE与PVA时胸降主动脉（DTA）的图像采集率以及B型AD的诊断率。两项检查均与以增强计算机断层扫描（CT）诊断的B型AD作为参考标准进行比较。我们还分析了影响使用PVA进行充分图像采集及B型AD诊断的因素。在CT图像上测量胸背部表面与DTA之间的长度（TDAL）以及TDAL线上的肺厚度（LTh）。
PVA与TTE对DTA的图像采集率之间未发现显著差异（70.1%对64.2%，p = 0.56），而使用PVA对B型AD的诊断率显著高于使用TTE时（56.7%对26.9%，p < 0.001）。此外，当使用PVA获得DTA的充分图像时，80.9%的患者被诊断为B型AD。多因素分析表明，较低的LTh（p = 0.001）和胸腔积液的存在（p = 0.03）显著影响使用PVA对B型AD的诊断。
当获得DTA的充分图像时，PVA可能是诊断B型AD的一种有用方法。
