ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 October;41(5):659-68

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Electron beam tomography with three-dimensional reconstruction in the diagnosis of aortic diseases

Lu B., Dai R., Jing B., Bai H., He S., Zhuang N., Sun L. *, Budoff M. J. **

From the Department of Radiology *Department of Cardiac and Vascular Surgery Cardiovascular Institute and FuWai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing, China, 100037 **Department of Medicine, Division of Cardiology Harbor-UCLA Medical Center and Saint John’s Cardiovascular Research Center Torrance, CA, USA

Background. This ­study was per­formed to eval­u­ate the pro­to­cols of elec­tron ­beam tom­o­graph­ic angio­gra­phy and ­three-dimen­sion­al recon­struc­tion for assess­ing the diag­nos­tic val­ue of aor­tic dis­eas­es.
Methods. Experimental ­design: Retrospective and com­par­a­tive ­study. Settings: University hos­pi­tal. Patients: Between 1996 and 1998, 189 cas­es who under­went elec­tron ­beam tom­o­graph­ic angio­gra­phy and diag­nosed ­with aor­tic dis­eas­es ­were ana­lyzed ret­ro­spec­tive­ly. The ­results ­were com­pared ­with sur­gi­cal and path­o­log­i­cal find­ings in 68 cas­es. Electron ­beam tom­o­graph­ic angio­gra­phy was ­used sin­gle-­slice-scan­ning ­with ECG-trig­ger­ing for screen­ing of the tho­rac­ic aor­ta, con­tin­u­ous-vol­ume-scan­ning, per­mit­ted by con­tin­u­ous X-ray expo­sure ­with ­table incre­men­tion, was per­formed for the abdom­i­nal aor­ta scan­ning with­out ECG-trig­ger­ing. Three-dimen­sion­al recon­struc­tions ­were per­formed ­with shad­ed-sur­face dis­play, mul­ti­pla­nar refor­mat­ting and/or max­i­mum inten­sity pro­jec­tion meth­ods.
Results. Electron ­beam tomog­ra­phy angio­gra­phy ­with ECG-trig­gered sec­tions of sin­gle-­slice-scan­ning ­improved the ­image qual­ity of the ascend­ing aor­ta with­out ­motion arti­facts. Continuous-vol­ume-scan­ning was suit­able for screen­ing of the abdom­i­nal aor­ta ­because of min­i­miz­ing expo­sure ­time (10-14 sec) and sav­ing con­trast ­media (total con­trast mate­ri­al of 45.5±6.6 ml was need­ed). One hundred eighty-nine cas­es ­were diag­nosed ­with aor­tic dis­sec­tion (97 cas­es), aor­tic aneu­rysm (26 cas­es), pseu­do­aneu­rysm (8 cas­es), Marfan’s syn­drome (39 cas­es), Takayasu’s arter­itis (5 cas­es) and con­gen­i­tal aor­tic mal­for­ma­tions (14 cas­es). Electron ­beam tomog­ra­phy ­results ­were com­pared ­with the find­ings of sur­gery (as ­gold stan­dard) in 68 cas­es, the diag­nos­tic accu­ra­cy was 97% (2 cas­es ­with aor­tic aneu­rysm ­were erro­ne­ous­ly diag­nosed ­with pseu­do­aneu­rysm).
Conclusions. Electrocardiographically trig­gered, con­trast-­enhanced elec­tron ­beam tomog­ra­phy is fea­sible for the diag­no­sis of all ­kinds of aor­tic dis­eas­es, ­with excel­lent ­three-dimen­sion­al imag­es com­pet­i­tive in qual­ity ­with con­ven­tion­al selec­tive aor­tic angio­gra­phy or dig­i­tal sub­trac­tion angio­gra­phy.