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本文探讨了双源计算机断层扫描(DSCT)大螺距扫描在重度主动脉瓣狭窄(AS)经导管主动脉瓣植入(TAVI)术前评价中的可行性。课题组以30例重度主动脉瓣狭窄TAVI术前患者行DSCT大螺距颈部-股动脉联合血管造影,测量评价主动脉及入路血管CT值,并计算强化对比、对比噪声比(CNR)及噪声。研究评价了主动脉根部及入路血管测量值的观察者内及观察者间一致性,同时评价了主动脉及入路血管形态和斑块形成情况。主动脉及入路血管强化对比、CNR及噪声分别为348.2~457.9HU、12.2~30.3 HU和19.1~48.1 HU。主动脉根部及入路血管观察者内和观察者间测量重复性良好(平均差值:-0.73~0.79mm,r=0.90~0.98,P<0.001;平均差值:-0.70~0.73mm,r=0.90~0.96,P<0.001)。30例患者中,5例患者(16.7%)髂外动脉、股动脉或锁骨下动脉直径小于7mm。1例患者(3.3%)双侧髂总动脉明显钙化伴管腔狭窄。1例患者(3.3%)左髂总动脉明显软斑块形成。研究结果说明,利用DSCT大螺距扫描在重度主动脉瓣TAVI术前评价主动脉根部及入路血管是可行的。
This article explores the feasibility of double-source computed tomography (DSCT) large-pitch scanning in the preoperative evaluation of severe aortic stenosis (AS) under catheter aortic valve implantation (TAVI). In our study, 30 patients with severe aortic stenosis before TAVI underwent DSCT large-pitch neck-femoral artery angiography. The CT values of the aorta and the approach blood vessels were measured and evaluated. Contrast-to-noise ratio (CNR) and noise. The study evaluated the intraobserver and interobserver agreement of aortic root and access vessel measurements, and assessed aorta and access vessel morphology and plaque formation. Comparisons of aortic and portal vascular enhancement showed CNR and noise were 348.2-457.9 HU, 12.2-30.3 HU and 19.1-48.1 HU, respectively. The aortic root and access vascular observers measured within and between observers had good reproducibility (mean difference: -0.73 to 0.79 mm, r = 0.90 to 0.98, P <0.001; mean difference: -0.70 to 0.73 mm, r = 0.90 ~ 0.96, P <0.001). Of the 30 patients, 5 (16.7%) had less than 7 mm in diameter of the external iliac artery, femoral artery or subclavian artery. One patient (3.3%) had bilateral common iliac artery calcification with stenosis. One patient (3.3%) had a clear soft plaque on the left common iliac artery. The results show that the use of DSCT large pitch scanning in severe aortic valve TAVI preoperative assessment of the aortic root and access to blood vessels is feasible.