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目的探讨MRA诊断主动脉夹层动脉瘤的价值。方法2000年10月至2002年12月,136例患主动脉疾病的病人术前经trueFISP3DCEMRA影像学检查,并与术中主动脉病理改变进行对比研究。病人男116例,女20例;平均年龄(45.5±12.2)岁。分为主动脉夹层动脉瘤组108例,急诊发病(发病时间小于2周)76例,包括I型夹层动脉瘤41例,II型夹层动脉瘤9例,IIIA夹层动脉瘤1例,IIIB夹层动脉瘤57例;非夹层动脉瘤组28例,包括升主动脉瘤9例,马方根部瘤6例,降主动脉脉假性动脉瘤5例,降主动脉瘤4例,升主动脉假动脉瘤、降主动脉缩窄、弓部瘤、弓部假性动脉瘤各1例。结果术前MRA诊断与术中所见对比显示,MRA对主动脉夹层动脉瘤及其累及范围诊断的敏感性及特异性均为100%;撕裂位置诊断的敏感性为85.2%,特异性100%;头臂干受累情况诊断的敏感性为90.3%,特异性为100%;心包及胸腔积液诊断的敏感性及特异性均为100%;假腔内血流情况诊断的敏感性为98.1%,特异性为100%。结论trueFISP3DCEMRA技术对主动脉夹层动脉瘤的诊断安全、可靠,基本可取代常规血管造影,被视为主动脉夹层动脉瘤和其他主动脉疾病诊断的“金标准”。
Objective To investigate the value of MRA in the diagnosis of aortic dissection aneurysm. Methods From October 2000 to December 2002, 136 patients with aortic diseases underwent trueFISP3DCEMRA imaging before surgery, and compared with the pathological changes of the aorta during operation. There were 116 males and 20 females with a mean age of (45.5 ± 12.2) years. Divided into aortic dissection aneurysm group of 108 cases, the incidence of emergency (onset time less than 2 weeks) in 76 cases, including type I dissection in 41 cases, type II dissection in 9 cases, IIIA dissection aneurysm in 1 case, IIIB dissection 57 cases of aneurysm; 28 cases of non-dissecting aneurysm group, including ascending aortic aneurysm in 9 cases, 6 cases of root-side tumor, descending aorta pseudoaneurysm in 5 cases, descending aortic aneurysm in 4 cases, ascending aorta false artery Aneurysm, thoracic aorta narrowing, bow tumor, and bow pseudoaneurysm in 1 case. Results The preoperative MRA diagnosis showed that the sensitivity and specificity of MRA in the diagnosis of aortic dissection aneurysm and its involved range were both 100%. The diagnostic sensitivity of tear location was 85.2% and the specificity of 100 %; The diagnostic sensitivity of head trunk involvement was 90.3%, specificity was 100%; the sensitivity and specificity of pericardial and pleural effusion diagnosis were 100%; the sensitivity of false lumen flow diagnosis was 98.1 %, Specificity 100%. Conclusion The trueFISP3DCEMRA technique is safe and reliable for the diagnosis of aortic dissecting aneurysms and can replace conventional angiography. It is regarded as the “gold standard” for the diagnosis of aortic dissecting aneurysms and other aortic diseases.