Xiao Z Y, Wang H J, Yao C L, Gu G R, Xue Y, Yin J, Chen J, Zhang C, Tong C Y, Song Z J
Department of Emergency, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Mar 24;45(3):217-222. doi: 10.3760/cma.j.issn.0253-3758.2017.03.009.
To explore the imaging manifestations of multi-slice spiral CT angiography (CTA) and relationship with in-hospital death in patients with aortic dissection (AD). The clinical data of 429 patients with AD who underwent CTA in Zhongshan Hospital of Fudan University between January 2009 and January 2016 were retrospectively analyzed. AD patients were divided into 2 groups, including operation group who underwent surgery or interventional therapy (370 cases) and non-operation group who underwent medical conservative treatment(59 cases). The multi-slice spiral CTA imaging features of AD were analyzed, and multivariate logistic regression analysis was used to investigate the relationship between imaging manifestations and in-hospital death in AD patients. There were 12 cases (3.24%) of in-hospital death in operation group, and 28 cases (47.46%) of in-hospital death in non-operation group(<0.001). AD involved different vascular branches. Multi-slice spiral CTA can clearly show the dissection of true and false lumen, and intimal tear was detected in 363 (84.62%) cases, outer wall calcification was revealed in 63 (14.69%) cases, and thrombus formation was present in 227 (52.91%) cases. The multivariate logistic regression analysis showed that the number of branch vessels involved (=1.374, 95% 1.081-1.745, =0.009) and tearing false lumen range(=2.059, 95% 1.252-3.385, =0.004) were independent risk factors of in-hospital death in AD patients, and the number of branch vessels involved (=1.600, 95% 1.062-2.411, =0.025) was independent risk factor of in-hospital death in the operation group, while the tearing false lumen range (=2.315, 95% 1.019-5.262, =0.045) was independent risk factor of in-hospital death of non-operation group. Multi-slice spiral CTA can clearly show the entire AD, true and false lumen, intimal tear, wall calcification and thrombosis of AD patients. The number of branch vessels involved and tearing false lumen range are the independent risk factors of in-hospital death in AD patients.
探讨多层螺旋CT血管造影（CTA）在主动脉夹层（AD）患者中的影像学表现及其与院内死亡的关系。回顾性分析2009年1月至2016年1月在复旦大学附属中山医院行CTA检查的429例AD患者的临床资料。将AD患者分为2组，包括接受手术或介入治疗的手术组（370例）和接受内科保守治疗的非手术组（59例）。分析AD的多层螺旋CTA影像学特征，并采用多因素logistic回归分析探讨AD患者影像学表现与院内死亡的关系。手术组院内死亡12例（3.24%），非手术组院内死亡28例（47.46%）（<0.001）。AD累及不同血管分支。多层螺旋CTA能清晰显示真假腔的分离，363例（84.62%）检测到内膜撕裂，63例（14.69%）显示外壁钙化，227例（52.91%）存在血栓形成。多因素logistic回归分析显示，累及分支血管数量（=1.374，95%可信区间1.081 - 1.745，=0.009）和撕裂假腔范围（=2.059，95%可信区间1.252 - 3.385，=0.004）是AD患者院内死亡的独立危险因素，累及分支血管数量（=1.600，95%可信区间1.062 - 2.411，=0.025）是手术组院内死亡的独立危险因素，而撕裂假腔范围（=2.315，95%可信区间1.019 - 5.262，=0.045）是非手术组院内死亡的独立危险因素。多层螺旋CTA能清晰显示AD患者的全貌、真假腔、内膜撕裂、壁钙化和血栓形成。累及分支血管数量和撕裂假腔范围是AD患者院内死亡的独立危险因素。
