【摘要】 目的 评估急性Stanford A型主动脉夹层累及冠状动脉的多层螺旋CT血管成像(MSCTA)特征及术前诊断价值。方法 回顾性分析2015年1月至2021年10月A型主动脉夹层且术前行MSCTA扫描的374例患者资料，手术证实冠状动脉受累107例。结果 将手术作为金标准，MSCTA诊断右冠状动脉(RCA)受累的敏感性、特异性、阳性预测值、阴性预测值分别为84.2%、98.6%、95.2%、94.8%,Kappa=0.854；左冠状动脉(LCA)分别为88.9%、100%、100%、98.5%,Kappa=0.934。冠状动脉受累分为三种情况，Neri A型56例(开口夹层)，Neri B型20例(夹层的内膜撕裂延伸进入管腔内)，Neri C型15例(开口离断)。RCA受累的患病率高于LCA(P<0.001)。在三种病变类型中受累侧有显著差异：Neri A型和C型多发生在RCA(P<0.05)。结论 MSCTA可以准确辨别冠状动脉受累特征,有助于临床术前早期诊断，帮助术者合理选择手术方式，改善预后。更多还原

【Abstract】 Objective To evaluate the characteristics and preoperative diagnostic value of multi-slice spiral CT angiography(MSCTA) of acute Stanford A aortic dissection involving coronary arteries. Methods The data of 374 patients with acute Stanford type A aortic dissection and MSCTA scan before surgery were analyzed retrospectively from January 2015 to October 2021,107 cases of coronary involvement were confirmed by operation. Results Taking surgery as the gold standard, the sensitivity,specificity,positiv e predictive value and negative predictive value of MSCTA for the diagnosis of RCA involvement were 84.2%, 98.6%, 95.2% and 94.8%,respectively,kappa= 0.854;The above 4 indexes of LCA involvement were 88.9%, 100%, 100% and 98.5%, respectively, Kappa=0.934. Coronary involvement were divided into three types, type Neri A lesion in 52 cases(ostial dissection);type Neri B lesion in 16 cases(dissection with intimal tearing into the inner of the coronary); type Neri C lesion in 11 cases(ostial detachment).The RCA was more frequently affected than the LCA(P<0.001).The side of the affected CA differed significantly among the three lesion types:the RCA was more commonly affected in patients with type A lesion and type C lesion(P>0.05). Conclusion MSCTA can accurately distinguish the characteristics of coronary involvement, and is helpful for early diagnosis before operation, reasonable selection of operation methods and improving prognosis.更多还原