| ObjectiveA retrospective study of multi-slice spiral CT(Multi-slice Computed Tomography) in aortic dissection(Aortic dissection, AD) in the assessment of aortic structure and function in patients with the use value.In order to provide reliable operation before the imaging basis for clinicians in the diagnosis and treatment of AD,mainly divided into the following two aspects:(1)Application value of multi-slice spiral CT and 3D imaging technique in the clinical diagnosis of aortic dissection;(2)According to the multi slice spiral CT scan results, change the evidence that it can provide us with the structure and function of patients with aortic dissection of the aorta,and the application of the results to explore its relationship with hypertension and arteriosclerosis contact.MethodThe object of study:From 2013 March to 2014 since October,the patients in our hospital were cardiovascular department of internal medicine and cardiovascular surgery, a total of 243 cases, grouping research. The normal control group of 73 cases,including 45 cases of male, female 28 cases, mean age 50.44±7.23 years;hypertension group were 78 cases, including 49 cases of male, female 29 cases, mean age 51.38±9.83 years; aortic dissection group(AD group) 92 cases, including 64 cases of male, female 28 cases, mean age 50.28±8.47 years.We analyzed the aorta of multi-slice spiral CT(MSCT) examination in patients with a total of 243 cases,the analysis is focused on the entire aortic dissection involvement, branch artery dissection tired and scope, the true lumen and false lumen diameter, the location of the rupture and size, vascular malformation and mutation. According to the reading result, observe the site to determine the location of the rupture of aortic, aortic dissection involving, range, the existence of atherosclerotic plaques, and record the plaque size, position and shape data. Measurement of aortic root, annulus level, ascending aorta, aortic arch wide at the widest point, such as the location of the inner diameter of the aortic arch isthmus. Patients with ultrasound Beckoning map acquisition part, chest and other imaging data and check for comparative study.Result(1) The parameters are checked by the measured value of aorta compared:Each part of hypertension group and AD group of patients with aortic(ascending aorta, aortic arch and descending aorta) and inner diameter of normal control group compared with the inner diameter of each part have the obvious enlargement; each part of AD group patients with aortic diameter than the hypertension group was significantly more expanded.(2) Compare the value of measurement of each parameter in hypertension group: the aorta compared with stage 1 hypertension patients and 2 level, the inner diameter of each part of grade 3 hypertension patients were enlarged aorta.The results show that, the various parts of hypertensive patients with aortic diameter is increased, and the inner diameter increases with the increase of the aggravate hypertension grading.(3) The subjects occurred rate of atherosclerotic plaque: a total of 9 cases of normal detection of atherosclerotic plaque in the control group, the incidence rate of about12.32%; hypertension group were detected 55 cases of atherosclerotic plaque, there were approximately 70.51%. Compared with the control group, the incidence rate of plaque in hypertension group was significantly increased, with statistical significance(P<0.001). The AD group has a total of 79 patients were detected in atherosclerotic plaque occurrence rate is about 85.86%. Compared with the control group and hypertension group, AD group, plaque incidence rate increased, and there was statistical significance.The results above indicate that the AD group of atherosclerotic plaque is the most serious.(4) Detected in AD group the intimal tear: According to De Bakey classification, 34 cases of type I and type II in 4 cases of AD patients, the breach in the ascending aorta,another 2 cases patients with type I AD in rupture of aortic arch, part of blood by reverse flow and the formation of interlayer breach of invasion and the aortic arch and the ascending aorta artery; 3 patients with type I AD for double break(ascending aorta and aortic arch), 1 cases of damaged position is not clear, confirmed by surgery in the left subclavian artery distal; 41 cases of type III AD patients, including 38 cases of rupture in the left subclavian artery in the distance, 3 cases by reading was not detected in the clear film break. 5 patients gave up treatment at discharge and 2patients died before surgery patients were not confirmed by operation; of which 78 cases were confirmed by operation and CT diagnosis with the location of the rupture,the coincidence rate is 96.29%, break detection rate was 95.65%.Conclusion(1)The aortic structure and function in patients with essential hypertension have obvious changes, the main performance is the position of the aorta diameter expanded,and this is consistent with the classification of hypertension, increased with the grade of hypertension, the above changes aggravate;(2) The changes in aortic structure and function in patients with aortic dissection than simple hypertension group, aortic diameter expanding is more obvious, the severity of atherosclerosis;(3) The changes of structure and function of the aortic and atherosclerosis is the pathological basis of the occurrence and development of aortic dissection, the hypertension is the initial factor of these pathological changes;(4) Multi slice spiral CT is an important examination,Especially in the location of the rupture, dissection involving the scope, have important directive significance for the evaluation of clinicians in the choice of operation mode and preoperative. |
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