【摘要】 目的探讨胸痛中心应用MDCT平扫,在筛查主动脉夹层(AD)患者中的临床价值。方法收集本院胸痛中心筹建以来MDCT平扫疑诊AD,并有完整MDCT及CTA资料患者共计78例,记录6个与AD相关MDCT征象的阳性率,计算MDCT筛查AD的灵敏度,并比较Stanford A、B型AD在各MDCT征象阳性率的差异,分析致死AD患者MDCT影像学特征。结果 72例MDCT阳性患者经CTA确诊为AD,Stanford A、B型AD分别有26、46例。6例MDCT平扫为假阳性结果,MDCT筛查AD的灵敏度为92.3%;在MDCT筛查中AD直接征象和间接征象阳性率分别为97.2%和88.9%。主动脉腔内异常密度影及心包积液阳性率在A型AD中高于B型AD(P<0.05)。钙斑内移征象阳性率随年龄增大增多(P=0.017)。A、B型AD入院72h内死亡率为23.1%、17.4%,MDCT直接及间接征象在致死AD阳性率均为100%,心包积液、主动脉增粗是AD导致死亡的危险因素(P<0.05)。结论 MDCT对AD的筛查具有较高的敏感度,可作为胸痛中心首选的检查方法,A、B型AD及致死AD在MDCT影像学征象各有特点。更多还原

【Abstract】 Objective To explore the clinical value of emergency MDCT scan in screening aortic dissection(AD) in the chest pain center. Methods A total of 78 patients with suspected aortic dissection in MDCT were collected since the establishment of the hospital chest pain center, and all of 78 patients underwent MDCT and CTA. The positive rates of these 6 MDCT findings related to AD were calculated. The sensitivity of MDCT in screening AD was calculated. The positive rate of MDCT signs between Stanford A and B AD was compared by statistical analysis. The imaging features of MDCT in patients with fatal AD were analyzed. Results 72 patients were diagnosed as AD according to CTA, 26 cases were type A and 46 cases were type B. 6 cases of MDCT were false-positive. MDCT sensitivity was 92.3 %. The positive rates of direct and indirect signs of AD in MDCT screening were 97.2% and 88.9%, respectively. The positive rate of abnormal density and pericardial effusion in type A AD was higher than that in type B AD(P<0.05). The positive rate of calcium plaque migration increased by age increase(P=0.017). Within 72 hours of admission, the death rate of type A and B AD was 23. 1% and 17. 4%, respectively. The positive rate of direct and indirect MDCT signs in lethal AD both was 100%. Pericardial effusion and aortic thickening were risk factors for death of AD(P<0.05). Conclusion MDCT has high sensitivity in screening of AD, so it can be used as the first choice for the examination of chest pain center. Type A, B AD and higher mortality risk AD have different characteristics in MDCT imaging.更多还原