Evangelista A, Garcia-del-Castillo H, Gonzalez-Alujas T, Dominguez-Oronoz R, Salas A, Permanyer-Miralda G, Soler-Soler J
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
J Am Coll Cardiol. 1996 Jan;27(1):102-7. doi: 10.1016/0735-1097(95)00414-9.
This study sought to assess the reliability of biplanar transesophageal echocardiography in the diagnosis of ascending aortic dissection and to test the utility of M-mode information in the differential diagnosis of ascending aortic ultrasound artifacts and intimal flap images.
Transesophageal echocardiography is a useful technique in the diagnosis of aortic dissection. However, ultrasound artifacts in the ascending aorta are an important limitation.
Transesophageal echocardiography was performed in 132 consecutive patients with clinically suspected aortic dissection. Two-dimensional and M-mode echocardiography and color Doppler were used to diagnose intimal flap and artifact images. Diagnoses were validated either anatomically or with reference techniques.
The sensitivity and specificity of transesophageal echocardiography in the diagnosis of ascending aortic dissection were 96.8% and 100%, respectively. Ninety-three artifacts were observed in 56 (55%) of 101 patients without ascending aortic dissection. Two-dimensional echocardiography easily identified 74 artifacts (80%). Color Doppler showed no ascending flow abnormalities in 71% of artifact images. M-mode echocardiography showed three location and mobility artifact patterns related to the posterior wall of the aorta or the right pulmonary artery. In contrast, intimal flap movement showed no relation to the aortic wall movement in 25 cases (83%). Blind analysis of transesophageal echocardiographic study tapes underlined the utility of M-mode in the differential diagnosis. Ranges of sensitivity, specificity and positive predictive value (established by including doubtful results as either positive or negative) improved from 87.1-93.5% to 93.5-96.8%, from 85.1-94.1% to 99-100% and from 65.9-81.8% to 96.8-100%, respectively, with the inclusion of M-mode data.
Biplanar transesophageal echocardiography permits reliable diagnosis of ascending aortic dissection. Ultrasound artifacts are common, but assessment of the location and mobility of intraluminal images by M-mode echocardiography definitely improves diagnostic accuracy.
本研究旨在评估双平面经食管超声心动图在升主动脉夹层诊断中的可靠性，并测试M型信息在升主动脉超声伪像与内膜瓣图像鉴别诊断中的效用。
经食管超声心动图是诊断主动脉夹层的一项有用技术。然而，升主动脉中的超声伪像是一个重要限制因素。
对132例临床怀疑主动脉夹层的连续患者进行经食管超声心动图检查。使用二维和M型超声心动图以及彩色多普勒来诊断内膜瓣和伪像图像。诊断通过解剖学方法或参考技术进行验证。
经食管超声心动图诊断升主动脉夹层的敏感性和特异性分别为96.8%和100%。在101例无升主动脉夹层的患者中，56例（55%）观察到93个伪像。二维超声心动图轻松识别出74个伪像（80%）。彩色多普勒显示71%的伪像图像中无升主动脉血流异常。M型超声心动图显示与主动脉后壁或右肺动脉相关的三种位置和移动伪像模式。相比之下，25例（83%）内膜瓣运动与主动脉壁运动无关。对经食管超声心动图研究录像带进行盲法分析强调了M型在鉴别诊断中的效用。纳入M型数据后，敏感性、特异性和阳性预测值范围（将可疑结果视为阳性或阴性来确定）分别从87.1 - 93.5%提高到93.5 - 96.8%，从85.1 - 94.1%提高到99 - 100%，从65.9 - 81.8%提高到96.8 - 100%。
双平面经食管超声心动图可对升主动脉夹层进行可靠诊断。超声伪像很常见，但通过M型超声心动图评估腔内图像的位置和移动肯定能提高诊断准确性。
