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大動脈解離、Intramural hematoma(IMH)に対する全位相心電図同期CT angiographyの有用性の検討:大動脈解離における内膜損傷及びIMHにおける潰瘍状突出構造の検出

柳垣 聡 東北大学

2021.03.25

概要

【目的】
 急性期大動脈解離(Aortic dissection: AD)は臨床上稀ではあるが、高い死亡率を有する重篤な急性疾患である。特に、AD の病態において内膜損傷(Intimal tear: IT)の存在はその治療方針に影響を与える重要な因子である。また、Intramural hematoma(IMH)は、元来 AD とは独立した疾患と考えられていたが、最近では AD の発症後に偽腔が血栓化し閉鎖腔に変化した AD の亜型と考えられるようになっている。IMH 診療において、潰瘍状突出構造(Ulcer-like projection: ULP)の存在は患者の予後に影響する重要な因子であることが知られている。昨今、AD の画像診断において心電図同期 CT angiography(ECG-gated CTA)を応用する研究が報告されている。従来の論文では ECG-gated CTA はアーチファクトの軽減につながり画質全般の向上に寄与することが示される一方で、実際に治療方針の決定に重要な IT、 ULP の同定能向上に寄与しているか、また IT、 ULP の同定は心周期における拡張期単一位相における評価で充分かどうかについては、充分に検討されていない。本研究の目的は AD における IT、IMHにおける ULP の検出能について、心電図非同期 CT angiography(non-ECG-gated CTA)、拡張期単一位相心電図同期 CTA(diastolic single-phase ECG-gated CTA)、全位相心電図同期 CTA(full-phase ECG-gated CTA)を用いて、それぞれの精度を比較することである。

【対象と方法】
 救急外来にて AD 及び IMH と診断された連続 81 症例を後ろ向きに検討した。IT、ULPの検出には、non-ECG-gated CTA、diastolic single-phase ECG-gated CTA、full-phase ECG-gated CTA を用い、上行大動脈、大動脈弓部、近位下行大動脈、遠位下行大動脈における病変の有無をそれぞれ評価した。サブグループ解析として、その診断精度を AD 単独、IMH 単独、胸部大動脈の各解剖学的部位でそれぞれ比較した。

【結果】
 full-phase ECG-gated CTA の IT、ULP 検出の正診率(88% [95%CI: 100%, 75%])は、 non-ECG- gated CTA(72% [95%CI: 90%, 54%])、diastolic single-phase ECG-gated CTA(76% [95%CI: 93%, 60%])と比較し統計学的に有意に優れていた(P = 0.001,0.008)。AD 単独では、full-phase ECG-gated CTA の IT 検出の正診率 (90% [95% CI:96%, 84%])は、non-ECG-gated CTA(79% [95% CI: 87%, 71%])、diastolic single-phase ECG-gated CTA(79% [95% CI: 87%, 71%])いずれよりも統計学的有意に優れていた(P= 0.029, 0.020)。IMH 単独では、full-phase ECG-gated CTA の ULP 検出の正診率(90% [95% CI: 95%, 84%])は non-ECG-gated CTA(79% [95% CI: 87%, 72%])よりも統計学的に有意に優れていたが(P = 0.016)、diastolic single-phase ECG-gated CTA(88% [95% CI: 94%, 82%])との間には統計学的有意差を認めなかった(P = 0.15)。

【結論】
 AD における IT、IMH における ULP の検出において、non-ECG-gated CTA、diastolic single-phase ECG-gated CTA と比較し、full-phase ECG-gated CTA は統計学的有意に優れた正診率を有する。

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参考文献

1.Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and Clinicopathology of Aortic Dissection. Chest 2000;117:1271–8.

2.Fedak Paul W.M., Verma Subodh, David Tirone E., et al. Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve. Circulation 2002;106:900–4.

3.Peterss S, Mansour AM, Ross JA, et al. Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights. Journal of the American College of Cardiology 2016;68:1054–65.

4.日本循環器学会, 日本心臓外科学会, 日本胸部外科学会, et al. 2020年改訂版 大動脈瘤・大動脈解離診療ガイドライン.

5.JCS Joint Working Group. Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011). Circ J 2013;77:789–828.

6.Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissectionTask Force on Aortic Dissection, European Society of Cardiology. Eur Heart J 2001;22:1642–81.

7.Baliga RR, Nienaber CA, Bossone E, et al. The Role of Imaging in Aortic Dissection and Related Syndromes. JACC: Cardiovascular Imaging 2014;7:406–24.

8.Golledge J, Eagle KA. Acute aortic dissection. The Lancet 2008;372:55– 66.

9.Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897–903.

10.Pape LA, Awais M, Woznicki EM, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015;66:350–8.

11.Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003;108:628–35.

12.Ravichandran P, Harrington DM, Lovell MB, et al. Patterns of visceral and renal artery involvement in type B aortic dissections. Vasc Endovascular Surg 2013;47:5–8.

13.Wal-Visscher E van de, Nieuwenhuijsen GAP, Sambeek MRHM van, et al. Type B Aortic Dissection Resulting in Acute Esophageal Necrosis. Annals of Vascular Surgery 2011;25:837.e1-837.e3.

14.Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995;92:II113-121.

15.Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001;33:1185–92.

16.Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. Journal of Vascular Surgery 1988;7:199–209.

17.Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology 1997;203:37–44.

18.Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation 2004;109:3014–21.

19.Akutsu K, Morisaki H, Okajima T, et al. Genetic Analysis of Young Adult Patients With Aortic Disease Not Fulfilling the Diagnostic Criteria for Marfan Syndrome. Circulation Journal 2010;advpub:1003260660– 1003260660.

20.福本仁志. ERにおける急性大動脈解離の管理 (特集 ERにおける循環器疾患の管理) – (6 疾患各論). 救急医学 2002;26:1462–7.

21.Howard DPJ, Banerjee A, Fairhead JF, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study.Circulation 2013;127:2031–7.

22.Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2015 : Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2018;66:581–615.

23.Ueda T, Chin A, Petrovitch I, et al. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights into Imaging 2012;3:561–71.

24.Eggebrecht H, Plicht B, Kahlert P, et al. Intramural Hematoma and Penetrating Ulcers: Indications to Endovascular Treatment. European Journal of Vascular and Endovascular Surgery 2009;38:659–65.

25.Yanagaki S, Ueda T, Masuda A, et al. Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography. Jpn J Radiol 2020;38:1036–45.

26.Chin AS, Willemink MJ, Kino A, et al. Acute Limited Intimal Tears of the Thoracic Aorta. J Am Coll Cardiol 2018;71:2773–85.

27.Allen BD, Aouad PJ, Burris NS, et al. Detection and Hemodynamic Evaluation of Flap Fenestrations in Type B Aortic Dissection with 4D Flow MRI: Comparison with Conventional MRI and CT Angiography. Radiology: Cardiothoracic Imaging 2019;1:e180009.

28.Sueyoshi E, Matsuoka Y, Imada T, et al. New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation. Radiology 2002;224:536–41.

29.Chou AS, Ziganshin BA, Charilaou P, et al. Long-term behavior of aortic intramural hematomas and penetrating ulcers. The Journal of Thoracic and Cardiovascular Surgery 2016;151:361-373.e1.

30.Ganaha Fumikiyo, Miller D. Craig, Sugimoto Koji, et al. Prognosis of Aortic Intramural Hematoma With and Without Penetrating Atherosclerotic Ulcer. Circulation 2002;106:342–8.

31.Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237–47.

32.Debakey ME, Henly WS, Cooley DA, et al. SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA. J Thorac Cardiovasc Surg 1965;49:130–49.

33.WRITING GROUP MEMBERS, Hiratzka LF, Bakris GL, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121.

34.Saremi F, Hassani C, Lin LM, et al. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. RadioGraphics 2018;38:1949–72. 35.Kazui T, Washiyama N, Bashar AHM, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. The Annals of Thoracic Surgery 2002;74:75–81.

36.Charilaou P, Ziganshin BA, Peterss S, et al. Current Experience With Acute Type B Aortic Dissection: Validity of the Complication-Specific Approach in the Present Era. The Annals of Thoracic Surgery 2016;101:936–43.

37.Weiss G, Wolner I, Folkmann S, et al. The location of the primary entry tear in acute type B aortic dissection affects early outcome. Eur J Cardiothorac Surg 2012;42:571–6.

38.Thomas RP, Amin SS, Eldergash O, et al. Urgent Endovascular Treatment for Non-traumatic Descending Thoracic Aortic Rupture. Cardiovasc Intervent Radiol 2018;41:1318–23.

39.Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1546– 52.

40.Kaji Shuichiro, Nishigami Kazuhiro, Akasaka Takashi, et al. Prediction of Progression or Regression of Type A Aortic Intramural Hematoma by Computed Tomography. Circulation 1999;100:II–281.

41.Kitai T, Kaji S, Yamamuro A, et al. Clinical outcomes of medical therapy and timely operation in initially diagnosed type a aortic intramural hematoma: a 20-year experience. Circulation 2009;120:S292-298.

42.Song J-K, Yim JH, Ahn J-M, et al. Outcomes of patients with acute type a aortic intramural hematoma. Circulation 2009;120:2046–52.

43.Song JK, Kim HS, Kang DH, et al. Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta. J Am Coll Cardiol 2001;37:1604–10.

44.Nienaber Christoph A., Kische Stephan, Rousseau Hervé, et al.Endovascular Repair of Type B Aortic Dissection. Circulation: Cardiovascular Interventions 2013;6:407–16.

45.Matsuo H. The thrombosed type of aortic dissection—Its clinical features and diagnosis. Int J Angiol 1998;7:329–34.

46.Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873–926.

47.Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). American Journal of Cardiology 2002;89:1235– 8.

48.Mahesh M, Cody DD. Physics of Cardiac Imaging with Multiple-Row Detector CT. RadioGraphics 2007;27:1495–509.

49.Desjardins B, Kazerooni EA. ECG-Gated Cardiac CT. American Journal of Roentgenology 2004;182:993–1010.

50.Achenbach S, Ulzheimer S, Baum U, et al. Noninvasive Coronary Angiography by Retrospectively ECG-Gated Multislice Spiral CT.

51.Sun Z. Coronary CT angiography with prospective ECG-triggering: an effective alternative to invasive coronary angiography. Cardiovasc Diagn Ther 2012;2:28–37.

52.Qin J, Liu L, Meng X, et al. Prospective versus retrospective ECG gating for 320-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Clin Imaging 2011;35:193–7.

53.Shuman WP, Branch KR, May JM, et al. Prospective versus Retrospective ECG Gating for 64-Detector CT of the Coronary Arteries: Comparison of Image Quality and Patient Radiation Dose1. Radiology https://doi.org/10.1148/radiol.2482072192.

54.Kopp AF, Ohnesorge B, Flohr T, et al. [Cardiac multidetector-row CT: first clinical results of retrospectively ECG-gated spiral with optimized temporal and spatial resolution]. Rofo 2000;172:429–35.

55.Blanke P, Bulla S, Baumann T, et al. Thoracic Aorta: Prospective Electrocardiographically Triggered CT Angiography with Dual-Source CT—Feasibility, Image Quality, and Dose Reduction. Radiology 2010;255:207–17.

56.Kornberger A, Burck I, Beyrouti HE, et al. A low threshold to ECG-gated repeat CTA reduces the risk of false-positive diagnosis of type A dissection in interhospital referrals: a case series study. Ther Clin Risk Manag 2018;14:2019–27.

57.McMahon MA, Squirrell CA. Multidetector CT of Aortic Dissection: A Pictorial Review. RadioGraphics 2010;30:445–60.

58.Schernthaner RE, Stadler A, Beitzke D, et al. Dose modulated retrospective ECG-gated versus non-gated 64-row CT angiography of the aorta at the same radiation dose: comparison of motion artifacts, diagnostic confidence and signal-to-noise-ratios. Eur J Radiol 2012;81:e585-590.

59.Runza G, Fattouch K, Cademartiri F, et al. ECG-gated multidetector computed tomography for the assessment of the postoperative ascending aorta. Radiol Med 2009;114:705–17.

60.Wu W, Budovec J, Foley WD. Prospective and retrospective ECG gating for thoracic CT angiography: a comparative study. AJR Am J Roentgenol 2009;193:955–63.

61.Yang S, Li X, Chao B, et al. Abdominal aortic intimal flap motion characterization in acute aortic dissection: assessed with retrospective ECG-gated thoracoabdominal aorta dual-source CT angiography. PLoS ONE 2014;9:e87664.

62.Ganten M-K, Weber TF, von Tengg-Kobligk H, et al. Motion characterization of aortic wall and intimal flap by ECG-gated CT in patients with chronic B-dissection. Eur J Radiol 2009;72:146–53.

63.Beeres M, Bucher AM, Wichmann JL, et al. Improved visual delineation of the intimal flap in Stanford type A and B dissections at 3rd generation dual-source high-pitch CT angiography. Radiol Med 2016;121:573–9.

64.Evangelista Artur, Salas Armando, Ribera Aida, et al. Long-Term Outcome of Aortic Dissection With Patent False Lumen. Circulation 2012;125:3133– 41.

65.Ryan JT, Haygood TM, Yamal J-M, et al. The “Memory Effect” for Repeated Radiologic Observations. American Journal of Roentgenology 2011;197:W985–91.

66.Vos MJ, Uitdehaag BMJ, Barkhof F, et al. Interobserver variability in the radiological assessment of response to chemotherapy in glioma.Neurology 2003;60:826–30.

67.Hoang JK, Middleton WD, Farjat AE, et al. Interobserver Variability of Sonographic Features Used in the American College of Radiology Thyroid Imaging Reporting and Data System. American Journal of Roentgenology 2018;211:162–7.

68.Batra P, Bigoni B, Manning J, et al. Pitfalls in the Diagnosis of Thoracic Aortic Dissection at CT Angiography. RadioGraphics 2000;20:309–20.

69.Freeman LA, Young PM, Foley TA, et al. CT and MRI assessment of the aortic root and ascending aorta. AJR Am J Roentgenol 2013;200:W581-592.

70.Erbel R, Engberding R, Daniel W, et al. Echocardiography in diagnosis of aortic dissection. Lancet 1989;1:457–61.

71.Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection. Improved survival with less angiography. J Thorac Cardiovasc Surg 1994;108:567–74; discussion 574-575.

72.Cigarroa JE, Isselbacher EM, DeSanctis RW, et al. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med 1993;328:35–43.

73.Andersen ND, Ganapathi AM, Hanna JM, et al. Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program. J Am Coll Cardiol 2014;63:1796–803.

74.宇都宮大輔. これだけは知っておきたい心臓・血管疾患の画像診断. 東京;東京: 学研プラス; 2016.

75.Boos J, Raptopoulos V, Brook A, et al. Split-bolus intravenous contrast material injection vs. single-bolus injection in patients following endovascular abdominal aortic repair (EVAR). Abdom Radiol 2017;42:2551– 61.

76.Muroga K, Ichikawa K, Maruyama A, et al. Split-bolus injection protocol with optimized timings of contrast medium injection and CT scanning for 3D CT angio-venography before laparoscopic gastrectomy. Jpn J Radiol https://doi.org/10.1007/s11604-020-01069-2.

77.Choe YH, Phyun LH, Han B-K. Biphasic and Discontinuous Injection of Contrast Material for Thin-Section Helical CT Angiography of the Whole Aorta and Iliac Arteries. American Journal of Roentgenology 2001;176:454–6.

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