多排偵檢器電腦斷層在經導管主動脈瓣植入術的應用

Clinical Application of Multidetedtor Computed Tomography in Transcatheter Aortic Valve Implantation

鍾愛華(Ai-Hua Chung) ； 吳美翰(Mei-Han Wu) ； 張建法(Chien-Fa Chang) ； 邱怡友(Yi-You Chiou) ； 張政彥(Cheng-Yen Chang)

《臺灣醫事放射期刊》 2卷1期 (2014/01) Pp. 37-46

https://doi.org/10.6717/JTMRT.201401_2(1).0007

摘要

隨著平均壽命的延長，老年人口越來越多，患有主動脈瓣狹窄的病人也有增加的趨勢。在需要接受主動脈瓣膜植入手術的病人中，嚴重主動脈瓣狹窄是最常見的適應症。經導管主動脈瓣植入術(Transcatheter Aortic Valve Implantationt, TAVI)是目前唯一有效治療成人患有嚴重主動脈瓣狹窄之治療方式[1]。多排偵檢器電腦斷層在造影及技術不斷精進下，對瓣膜解剖位置、瓣膜旁滲漏、瓣膜血栓、有良好診斷能力。使外科醫師在開刀前能知道病人的瓣膜功能，主動脈瓣狹窄嚴重程度，種類及問題所在位置，有助臨床術前評估，讓手術過程更順利。我們使用多排偵檢器電腦斷層(Multidetector Computed Tomography, MDCT)對將要執行TAVI 的病人進行多切面電腦斷層血管造影檢查。利用高解析度二維多切面影像重組MPR(Multiplanner Reconstructions)，最大亮度投影MIP (Maximum Intensity Projection)，及3 維體積重建技術VRT (Volume Rendering Technique)影像，提供詳細解剖位置[2,3]。包括主動脈瓣環、主動脈竇尺寸、冠狀動脈開口與瓣環的距離、竇管連接處和瓣環上的主動脈直徑，利用全主動脈掃描，得到適合理想軸位角度，使臨床醫師在植入瓣膜時，是從股動脈或經心尖植入，提供有效且準確的資訊，對TAVI 術前臨床評估扮演一個不可或缺的角色[4]。

關鍵字

多排偵檢器電腦斷層 ； 經導管主動脈瓣植入術 ； 3維體積重建技術 ； 多切面影像重組 ； 最大亮度投影

並列摘要

As life expectancy increases, the elderly population, more and more patients suffering from aortic stenosis is also an increasing trend. In need of aortic valve replacement surgery patients, severe aortic stenosis is the most common indications. Transcatheter aortic valve implantation (TAVI) is currently the only effective treatment for adult patients with severe aortic stenosis in the treatment [1]. Multidetector CT angiography and technology continued to improve, thet valve anatomy, paravalvular leak, valve thrombosis, have good diagnostic capabilities. The surgeon to know the patient before surgery valvular aortic stenosis severity, type and location of the problem and help clinical preoperative evaluation, so that surgery process more smoothly. We use multi- detector computed tomography (MDCT) that will be executed TAVI of patients MDCT angiography. Using high-resolution 2DMPR(Multiplanner reconstruction) Maximum Intensity Projection, and 3D volume Rendering techniques VRT images provide detailed anatomical location [2,3]. Including the aortic annulus, aortic sinus size, coronary artery and valve ring distance sinus-tubular junction and the aortic valve annulus diameter, the whole aorta scan, to provide for the ideal axial angle, can provide clinical suitability from the femoral artery or transapical valve implantation method for TAVI preoperative clinical assessment plays an integral role in[4].

並列關鍵字

Multidetedtor Computed Tomography ； Transcatheter Aortic ValveImplantation ； Volume Rendering Technique ； Maximum Intensity Projection ； Multiplanner Reconstructions