利用ct血管造影三维生长作图评估胸升主动脉瘤主动脉弓受累。

IF 4.7 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
European Radiology Pub Date : 2025-06-01 Epub Date: 2024-11-30 DOI:10.1007/s00330-024-11239-9
Nicasius S Tjahjadi, Carlos Alberto Campello Jorge, Prabhvir Singh Marway, Heather A Knauer, Constantijn Hazenberg, Joost van Herwaarden, C Alberto Figueroa, Himanshu J Patel, Nicholas S Burris
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引用次数: 0

摘要

目的:我们通过血管变形测绘(VDM)研究术前弓生长,并检查近端弓直径如何很好地指示原发性上升动脉瘤的弓受累。方法和材料:本研究共纳入123例选择性胸升主动脉瘤(aTAA)修复术患者,伴有或不伴有足弓修复术,术前进行2次或以上ct血管造影(CTA)检查,至少间隔时间为10 ~ 22个月。我们比较了三维VDM分析测量的近端弓生长与标准直径测量的总体、扩张(≥40 mm)和非扩张(结果:30%的患者进行了同步(半)弓置换)。在59%的患者中,VDM生长和弓径评估是一致的,扩张弓组的VDM生长速率更高(0.46 mm/年vs 0.26 mm/年,p = 0.007),然而,未扩张弓的患者术前近端弓径在生长弓和非生长弓中相似(36.2 mm vs 35.9 mm)。在未扩张的弓中,26%的VDM显示有明显的增长,但标准直径测量没有。通过VDM和标准直径测量得出的弓形生长评估的一致性为73%;差异可达6毫米。在术后亚组中,12例(55%)患者显示原生主动脉弓生长(> - 0.3 mm/年),大多数(7/12,59%)患者术前CT显示主动脉弓未扩张。结论:通过直径阈值可靠评估aTAA的弓受累程度是有限的。VDM分析允许对上升动脉瘤的弓生长和累及进行更全面的分析,这可能有助于推进患者特定的手术计划。VDM测量的主动脉弓近端直径是否表明原发性升性动脉瘤累及主动脉弓近端?结果常规管径阈值与VDM存在差异;超过一半的近端弓扩张患者术前未见VDM生长。尽管术前不能通过标准测量准确评估其生长程度,但升主动脉瘤累及足弓是常见的。VDM是一种新兴技术,可提供弓生长的三维评估,并可为患者提供特定的修复策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessment of aortic arch involvement in ascending thoracic aortic aneurysm by three-dimensional growth mapping using CT-angiography.

Purpose: We investigated pre-surgical arch growth by vascular deformation mapping (VDM) and examined how well proximal arch diameter indicates arch involvement by the primary ascending aneurysm.

Methods and materials: A total of 123 patients who underwent elective repair of ascending thoracic aortic aneurysm (aTAA) with or without concomitant arch repair and had 2 or more pre-operative computed tomography angiography (CTA) studies with a minimum interval of > 22 months were included. We compared growth at the proximal arch measured by three-dimensional VDM analysis with standard diameter measurements in overall, dilated (≥ 40 mm), and non-dilated (< 40 mm) arch subgroups.

Results: Concurrent (hemi)arch replacement was performed in 30% of patients. In 59% of patients, VDM growth and arch diameter assessments were concordant VDM growth rate was higher in the dilated arch group (0.46 mm/year vs 0.26 mm/year, p = 0.007), however, pre-operative proximal arch diameter was similar in growth and non-growing arches among patients without arch dilation (36.2 mm vs 35.9 mm). Among non-dilated arches, 26% demonstrated significant growth by VDM but not by standard diameter measurements. Arch growth assessments by VDM and standard diameter measurements agreed with 73%; discrepancies up to 6 mm were observed. Within the post-operative subgroup, 12 (55%) patients demonstrated growth (> 0.3 mm/year) of the native aortic arch, with most (7/12, 59%) having non-dilated arches on pre-operative CT.

Conclusion: Reliable assessment of arch involvement in aTAA by diameter thresholds is limited. VDM analysis allows for a more comprehensive analysis of arch growth and involvement by the ascending aneurysm, which may be useful to advance patient-specific surgical planning.

Key points: Question Can VDM measured proximal aortic arch diameter indicate proximal arch involvement by a primary ascending aneurysm? Findings Discrepancies between arch dilation status by conventional diameter thresholds and VDM exist; over half of patients with dilated proximal arches demonstrated no growth by VDM pre-operatively. Clinical relevance Arch involvement is common in ascending aortic aneurysms, though the degree of growth is not accurately assessed pre-operatively by standard measurements. VDM is an emerging technique that provides a three-dimensional assessment of arch growth and may inform patient-specific repair strategies.

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来源期刊
European Radiology
European Radiology 医学-核医学
CiteScore
11.60
自引率
8.50%
发文量
874
审稿时长
2-4 weeks
期刊介绍: European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.
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