ct三维重建对主动脉弓降部stanford b型夹层的术前评估及与dsa的比较word格式论文.docxVIP

优秀毕业论文 精品参考文献资料 (4)本研究中在 DSA 下支架释放角度为 45°共 32 例（占 56.14%），角度为 46°～55°共 20 例（占 35.09%），角度为 56°～60°共 5 例，（占 8.77%， 这五例术前 CT 测量释放角度明显大于 45°并指导术中 DSA 进行了相应角度 调整），DSA 下支架释放角度中位数为 45°（P25=45°，P75=50°），CT 计 算释放角度中位数为 55°（P25=46°，P75=60°），支架释放后校正角度中位 数为 54°（P25=45°，P75=60°），DSA 下释放支架的角度与 CT 计算释放角 度的 spearman 秩相关系数 r =0.522（ P 0.001）；DSA 下释放支架的角度与释 放后校正角度的 spearman 秩相关系数 r =0.761（ P 0.001）。结果表明 DSA 下 释放支架的角度与 CT 计算的释放角度及支架释放后校正角度呈正相关。 结论：①对于破口位于弓降部的 Stanford B 型夹层，术前可利用 CT 三维 重建进行手术相关重要参数测量并可帮助选取支架和指导术中 DSA 更好的定 位，并且对近端锚定区主动脉腔直径的测量，CT 三维重建的测量值较 DSA 测 量值准确；②破口位于弓降部的 Stanford B 型夹层，对多数病例，DSA 投射角 度 45°时可以很好的展开主动脉弓，但也有部分病例在 45°时展开不佳，根据 术前 CT 三维重建的测量可预知这种角度的变化并帮助和指导术中进行相应调 整，使得支架的释放更精确，减少和避免了支架覆盖重要血管分支的可能；③ 无论 CT 或是 DSA 在评估时都有一定的优势和缺陷，专科医生要熟悉这些并在 诊断和治疗过程中灵活使用，相互补充。 关键词：主动脉夹层，CT 三维重建，DSA，释放角度  ABSTRACT Objective: To determine the value of CT three-dimensional(3D) reconstruction through measuring related parameters of Stanford B dissection which entry tear occurred in the aortic arch-descending section using CT 3D reconstruction and DSA,and analyzing the difference of related parameters between them before Stent-Graft placement, and investigating the more accurate angle to release the stents graft under DSA. Materials and methods: From December 2008 to February 2012 , 57 cases of Stanford B dissection which entry tear occurred in the aortic arch-descending section based on the design-criteria were collected ,MSCTA wase done for each case before operation. The methods of reconstruction included maximum density projection method(MIP),many plane reconstruction method(MPR),and surface reconstruction method(CPR).The measured parameters included the distance between the entry tear and the left subclavia artery, the size of entry tears, the diameter of true and false lumen, the better release angle from which all of important branches of aortic arch could be seen from CT and DSA images, the correction angle which aortic arch were better observed measured under DSA after stent-graft rele