DSCT在动脉弹性功能评估中的应用价值研究
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摘要
研究背景
动脉弹性(Aortic Elasticity)是指在单位压力作用下血管直径、横截面积或体积的变化,它依赖于血管的几何和机械特性,是动脉壁的功能学反映。动脉弹性降低,僵硬度增加被认为是一系列心血管疾病发生发展的独立影响因素。在动脉病变发展过程中,动脉弹性功能的改变往往早于动脉形态及管壁病变的临床可见改变,因此对动脉弹性功能改变的早期客观评价,将有利于相关心血管疾病的预防及治疗,从而有效地控制心血管疾病的发病率及死亡率。
目前对于动脉壁功能改变的直接结构观察和定量评估比较困难,临床上一般通过间接获得多种功能参数进行动脉弹性功能的评价。包括脉压、反射波增强指数(Augumentation Index, AI)、大、小动脉弹性指数(C1,C2)和脉搏波传导速度(Pulse Wave Velocity, PWV)等。各种弹性功能参数可通过特定仪器或相关的影像学方法获得。早期,超声技术被首先应用于动脉弹性的评估中,尤以浅表动脉为主,然而受操作者本身影响较大,重复性及一致性较差。随着影像技术的不断进展,MR以其优秀的软组织分辨率在心脏功能评价中得到应用,进而应用于大动脉管壁结构及功能的评价中,然而MR受到扫描时间及空间分辨率等各方面因素的影响,加之费用比较昂贵,未能普及应用。
以往CT主要应用于血管形态及解剖结构的显示,近年来其在心血管功能学评估中的应用得到发展。相关研究采用MSCT结合回顾性心电门控对主动脉进行多期采集,通过血管截面积的变化来评价其弹性功能,认为MSCT在血管弹性评估中具有可行性。双源CT实现了83ms的优秀时间分辨率,对患者心率的要求大大下降,结合心电门控技术,可以在心动周期的任意时相重组满意的图像,为准确评估动脉弹性及大范围人群的普及应用提供了客观条件。然而目前该技术尚缺乏足够的临床数据,其准确性及临床应用价值还需进一步研究。
目的
利用心电门控DSCT对健康人胸主动脉随心动周期的搏动规律进行研究,探讨其在动脉弹性评估中的可行性及潜在临床应用价值；并以此作为参考标准,观察动脉瘤处动脉壁的弹性变化规律,旨在寻找一种安全、客观的可用于动脉疾病形态及功能综合评估的有效方法。
材料与方法
1.实验研究：将碘普胺(350mg/ml)与盐水以1：32混匀,注入实验用硅胶管(内径约7.60mm),两端封堵后以一定弯曲弧度固定,利用DSCT进行扫描。采用血管半自动测量软件对DSCT扫描所得硅胶管重组图像进行10个层面的测量,层面间间距为10mm,评价血管自动测量软件的准确性。
2.健康者研究：收集2008.12-2010.04来我院行胸部大血管检查的2700名患者的病历资料,共筛选出56例无心血管疾病的相对健康者作为研究对象(男39例,女17例,平均年龄46±10),研究对象按年龄分为三组(A<40岁,B40-50岁,C>50岁)。所有研究对象均行回顾性心电门控下DSCT扫描,将扫描数据每间隔5%RR间期重建,以主动脉窦管结合部作为参考平面,测量其上25±2.5mm处升主动脉及同层降主动脉的平均直径及截面积,分析健康人群胸主动脉随心动周期的搏动规律及管壁弹性特点。动脉弹性评价指标包括心动周期中主动脉平均直径变化率(%Ao),可扩张度(AoD),顺应性(AoC)及僵硬度(AoSI)。
3.动脉瘤患者研究：收集11例动脉瘤患者资料(男9例,女2例,平均年龄65±9岁),动脉瘤最大直径R>5cm。采用回顾性心电门控DSCT扫描,原始数据每间隔5%RR间期进行数据重建,共20期。利用血管测量软件测量动脉瘤近端及动脉瘤最大径处管腔面积,评价动脉瘤管壁弹性变化特点。
结果
1.实验研究结果
利用血管半自动测量软件对硅胶管10个层面测量后得到硅胶管平均内径为7.64mm,与硅胶管实际内径7.6mm比较,相对误差为0.53%。误差主要发生于硅胶管两端的测量层面。
2.健康者研究结果
DSCT扫描图像显示强化动脉血管与周围组织对比明显,所有研究对象均准确测量。
2.1动脉搏动规律研究
随心脏搏动,主动脉管腔发生周期性变化,升主动脉(AA)最大管径及最小管径出现时相分别为24.02±4.99%,95%CI(22.68%,25.35%),93.5±4.04%,95%CI(92.4%,94.6%)；同层降主动脉(DA)最大管径及最小管径出现时相分别为25.63±4.77%,95%CI(24.35%,26.9%)及96.6±4.58%,95%CI(95.38%,97.83%),晚于升主动脉。最大及最小管径出现时相与心率无明显相关性(AA,r=0.251,p=0.189及r=0.126,p=0.514；DA,r=0.141,p=0.3及r=0.087,p=0.552)。
2.2动脉弹性评估
升主动脉(AA)与降主动脉(DA)相比,动脉直径、横截面积及AoC具有显著差异,%Ao及AoD无明显差异。降主动脉僵硬度与升主动脉不同,但仅在A组(age<40)具有明显统计学差异。
随年龄增加,主动脉在整个心动周期的直径及面积变化程度减小,弹性(%Ao,AoD, AoC)下降,僵硬度(AoSI)增大,年龄与各弹性参数间(%Ao, AoD, AoC及AoSI)的总体相关性在升主动脉为r=-0.747,-0.734,-0.545和0.650,降主动脉为r=-0.690,-0.681,-0.568和0.627(P<0.05or0.01)。不同年龄组及主动脉不同节段动脉弹性的年龄依赖性不同,以A组降主动脉的可扩张度与年龄最为相关(r=-0.828)。
3.动脉瘤患者研究结果
3.1动脉瘤近端及动脉瘤处管腔均随心脏搏动产生舒缩变化。动脉瘤近端面积-时相曲线呈上升-下降趋势,类似于胸段降主动脉；而动脉瘤处面积-时相曲线呈无规律的多次上升-下降趋势。
3.2动脉瘤近端可扩张度为AoDabove=(1.05±0.8) mmHg-1动脉瘤处为AoDaaa=(0.45±0.5)mmHg-1二者之间差异具有统计学意义(p<0.05)。与胸段降主动脉比较,动脉瘤近端AoD亦明显下降((1.05±0.8)vs(2.17±0.58)),二者之间具有显著统计学差异(p<0.01)。
结论
1.作为一种动脉弹性功能评价的新方法,DSCT可以在无需增加额外辐射剂量的前提下,完成动脉形态及功能学的综合评估；
2.动脉管腔随心脏搏动产生规律性变化,心脏收缩期扩张最大,舒张晚期扩张最小,降主动脉的舒缩时相晚于升主动脉；
3.动脉弹性随年龄增加而降低,不同年龄组及主动脉不同节段动脉弹性的年龄依赖性不同；
4.动脉瘤处管壁弹性小于非动脉瘤处及健康者,弹性下降与动脉瘤的发生发展存在相关性。
总之,DSCT结合血管半自动测量软件可准确评估动脉血管的弹性变化,在相关弹性病变早期检测及治疗效果评估方面具有潜在临床应用价值。
Background
Aortic elasticity is defined as the relative temporal change in vessel diameter or cross-sectional area through the cardiac cycle under per unit blood pressure. It depends on the geometrical and mechanical characteristic of the vessel, and is an important functional parameter of the aortic wall. The decrease of arterial elasticity or increase of stiffness is accepted as an independent influencing factor for a series of cardiovascular diseases. During the course of arterial diseases, the decrease of arterial elasticity usually occurred earlier than the morphological and structural changes which can be found by clinical methods. Therefore, aortic elasticity assessments early on may be benefit in preventing and curing arterial and cardiac diseases, and may also play an important role in lowing the incidence and death rate of the cardiovascular diseases.
Now, it is impossible to observe the structural changes of the arterial wall directly and the quantitative assessment of the functional changes of the artery is difficult, thus, a variety of functional parameters are used to reflect the aortic elasticity indirectly. Including pulse pressure, augmentation Index (AI), C1/C2, and pulse wave velocity (PWV) and so on. These functional parameters can be obtained by a particular instrument or varied imaging techniques. Early, ultrasound was firstly used in the assessment of arterial elasticity, especially in the superficial artery. However, the repeatability and consistency is poor affected by the operators. With the continuous advances in imaging technology, MR was used in the evaluation of cardiac function, and then applied to the evaluation of aortic wall structure and function. However, it was not widely accepted because of the long scanning time but low spatial resolution, also the expensive cost.
In the past, CT had been widely used in displaying morphology and anatomical structure of the vascular. Now, it is gradually applied in the evaluation of cardiovascular function. A previous study had reported that it was feasible to evaluate vessel elasticity by using electrocardiographically-gated MDCT through assessing changes of the cross-sectional area during the cardiac cycle. An additional tool is to use, DSCT thereby increasing available temporal resolution to83ms. This permits more accurate vessel measurements at higher heart rates, combined with ECG gating technology, all data during the cardiac cycle can be obtained, which provide a guarantee for the accurate assessment of arterial elasticity. However, there are still no adequate clinical data, the accuracy and clinical value of the technology needs further study.
This was first study to evaluate aortic elasticity in people without relative cardiovascular diseases, all subjects were selected from people undergoing DSCT examination for suspected coronary artery or aortic disease. Based on this, elasticity was also assessed in patients with abdominal artery aneurysms.
Purpose
To gain a new insight into the pulsating property and wall elasticity of the thoracic aorta in people without cardiovascular diseases and people with abdominal artery aneurysms using ECG-gated DSCT, the feasibility and potential clinical value of this technique in arterial function evaluation were discussed, aiming to find an objective and effective method for the comprehensive evaluation of the aortic diseases including morphology and function.
Materials and Methods
1. Experimental study:A silicone tube (inner lumen7.60mm) filled with Iohexol(350mg/ml) and saline(proportion1:32) was examined using DSCT after fixed in a certain radian. Ten different positions,10mm distance from each other, were measured with the vessel measurement prototype software, and the average measurement diameter was compared with the known diameter to verify the accuracy of the software.
2. Study in people without cardiovascular disease:56subjects (male39, female17, average age46±10years) with no cardiovascular disease, selected from2,700people, from Dec.2008to Apr.2010undergoing ECG-gated DSCT examination, were divided into three groups according to their age (A<40years, B40-50years, C>50years). CT data were reconstructed in5%step throughout the RR interval. Diameter and area were measured at the curve of the ascending aorta (AA) and at the same level of the descending aorta (DA), about25±2.5mm above the sinotubular junction. The pulsation and elasticity of the aorta were evaluated, and elastic parameters are%Ao, AoD, AoC and AoSI.
3. Study of abdominal artery aneurysm (AAA):11patients (male9, female2, average age65±9years) with AAA (R>5cm) were examined using ECG-gated DSCT. CT data were reconstructed in5%step throughout the RR interval. Areas were measured at the maximum lumen and AoD was used as the elastic parameter.
Results
1. Accuracy of vessel measurement prototype software:Ten different positions along the silicone tube were measured by vessel measurement prototype software. The extracted average inner diameter was7.64mm. Compared with the known tube diameter of7.60mm the resulting relative error was0.53%. The discordance mainly occurred at the end or start plane of the trace.
2. Results of people without cardiovascular disease The ECG-gated DSCT images showed good contrast between the enhanced vessels and the surrounding tissues for the aortic measurement
2.1Evaluation of pulsation regulation The aortic diameter changes periodically according to the cardiac cycle. The AA achieved the maximum average diameter at an RR interval of24.02±4.99%,95%CI (22.68%,25.35%) and the minimum average diameter at an RR interval of93.5±4.04%,95%CI (92.4%,94.6%) respectively. For the DA, the maximum was at25.63±4.77%,95%CI (24.35%,26.9%), and the minimum was at96.6±4.58%,95%CI (95.38%,97.83%). The phases of the maximum and minimum average diameter were compared in relation to the heart rate and found that there were no significant correlations between the phases and the mean heart rate (for the AA, maximum average diameter phase r=0.251, p=0.189and minimum average diameter phase r=0.126,p=0.514; for the DA, they were r=0.141,p=0.3and r=0.087,p=0.552).
2.2Aortic elasticity assessment There were significant differences between the AA and the DA for the diameter, area change over the cardiac cycle and AoC, whereas no significant difference for %Ao, AoD. The stiffness of the DA was different from that of the AA in all groups, but was only significant in group A.
There was an age-dependent decrease of%Ao, AoD, AoC and increase of AoSI, the correlation coefficients between the age and the elastic parameters (%Ao, AoD, AoC and AoSI) were r=-0.747,-0.734,-0.545and0.650for the AA; the values were-0.690,-0.681,-0.568and0.627for the DA;(P<0.05or0.01). Whereas, the age-dependent trend was different between various age groups and between different elastic parameters, which was more significant in group A with the AoD (r=-0.711for the AA and-0.828for the DA).
3. Results of patients with AAA
3.1Evaluation of pulsation regulation
Both proximal of the aneurysm and the lumen of the aneurysm all changes according to the cardiac cycle. The area-versus-time curve at the proximal of the aneurysm demonstrates up-and-down trend similar to the thoracic descending aorta; while area-versus-time curve demonstrates multiple up-and-down trend without exactly regular pattern.
3.2Aortic elasticity assessment
AoD at the proximal of the aneurysm and the aneurysm portion was (1.05±0.8) mmHg-1and (0.45±0.5) mmHg-1respectively, there were statistical differences between them (p<0.05). Comparing to the thoracic descending aorta, there was significant decrease at the proximal of the aneurysm which was (1.05±0.8) vs (2.17±0.58)(p<0.01).
Conclusions
1. As an new non-invasive method, the morphologic and functional evaluation can be obtained at the same time by using DSCT without additional radiation dose;
2. The lumen of the aorta changes regularly according to the cardiac cycle, the maximum diameter occurred at the systolic time, and the minimum at late of the diastolic time, the time of descending aorta was later than that of the ascending aorta;
3. There was an age-dependent decrease of the elasticity, whereas, the age-dependent trend was different between various age groups and between different elastic parameters;
4. Elasticity at the aneurysm was significantly decreased comparing with the healthy arterial wall and the proximal part of it, the development of aneurysm related closely to the decrease of the elasticity.
In conclusion, the properties of aortic pulsation and wall elasticity could be well shown by ECG-gated DSCT both in healthy people and patient with aneurysm, as a potentially useful noninvasive method, retrospective ECG-gated DSCT can provide valuable functional information of the aorta as well as showing the structural changes.
动脉弹性(Aortic Elasticity)是指在单位压力作用下血管直径、横截面积或体积的变化,它依赖于血管的几何和机械特性,是动脉壁的功能学反映。动脉弹性降低,僵硬度增加被认为是一系列心血管疾病发生发展的独立影响因素。在动脉病变发展过程中,动脉弹性功能的改变往往早于动脉形态及管壁病变的临床可见改变,因此对动脉弹性功能改变的早期客观评价,将有利于相关心血管疾病的预防及治疗,从而有效地控制心血管疾病的发病率及死亡率。
目前对于动脉壁功能改变的直接结构观察和定量评估比较困难,临床上一般通过间接获得多种功能参数进行动脉弹性功能的评价。包括脉压、反射波增强指数(Augumentation Index, AI)、大、小动脉弹性指数(C1,C2)和脉搏波传导速度(Pulse Wave Velocity, PWV)等。各种弹性功能参数可通过特定仪器或相关的影像学方法获得。早期,超声技术被首先应用于动脉弹性的评估中,尤以浅表动脉为主,然而受操作者本身影响较大,重复性及一致性较差。随着影像技术的不断进展,MR以其优秀的软组织分辨率在心脏功能评价中得到应用,进而应用于大动脉管壁结构及功能的评价中,然而MR受到扫描时间及空间分辨率等各方面因素的影响,加之费用比较昂贵,未能普及应用。
以往CT主要应用于血管形态及解剖结构的显示,近年来其在心血管功能学评估中的应用得到发展。相关研究采用MSCT结合回顾性心电门控对主动脉进行多期采集,通过血管截面积的变化来评价其弹性功能,认为MSCT在血管弹性评估中具有可行性。双源CT实现了83ms的优秀时间分辨率,对患者心率的要求大大下降,结合心电门控技术,可以在心动周期的任意时相重组满意的图像,为准确评估动脉弹性及大范围人群的普及应用提供了客观条件。然而目前该技术尚缺乏足够的临床数据,其准确性及临床应用价值还需进一步研究。
目的
利用心电门控DSCT对健康人胸主动脉随心动周期的搏动规律进行研究,探讨其在动脉弹性评估中的可行性及潜在临床应用价值；并以此作为参考标准,观察动脉瘤处动脉壁的弹性变化规律,旨在寻找一种安全、客观的可用于动脉疾病形态及功能综合评估的有效方法。
材料与方法
1.实验研究：将碘普胺(350mg/ml)与盐水以1：32混匀,注入实验用硅胶管(内径约7.60mm),两端封堵后以一定弯曲弧度固定,利用DSCT进行扫描。采用血管半自动测量软件对DSCT扫描所得硅胶管重组图像进行10个层面的测量,层面间间距为10mm,评价血管自动测量软件的准确性。
2.健康者研究：收集2008.12-2010.04来我院行胸部大血管检查的2700名患者的病历资料,共筛选出56例无心血管疾病的相对健康者作为研究对象(男39例,女17例,平均年龄46±10),研究对象按年龄分为三组(A<40岁,B40-50岁,C>50岁)。所有研究对象均行回顾性心电门控下DSCT扫描,将扫描数据每间隔5%RR间期重建,以主动脉窦管结合部作为参考平面,测量其上25±2.5mm处升主动脉及同层降主动脉的平均直径及截面积,分析健康人群胸主动脉随心动周期的搏动规律及管壁弹性特点。动脉弹性评价指标包括心动周期中主动脉平均直径变化率(%Ao),可扩张度(AoD),顺应性(AoC)及僵硬度(AoSI)。
3.动脉瘤患者研究：收集11例动脉瘤患者资料(男9例,女2例,平均年龄65±9岁),动脉瘤最大直径R>5cm。采用回顾性心电门控DSCT扫描,原始数据每间隔5%RR间期进行数据重建,共20期。利用血管测量软件测量动脉瘤近端及动脉瘤最大径处管腔面积,评价动脉瘤管壁弹性变化特点。
结果
1.实验研究结果
利用血管半自动测量软件对硅胶管10个层面测量后得到硅胶管平均内径为7.64mm,与硅胶管实际内径7.6mm比较,相对误差为0.53%。误差主要发生于硅胶管两端的测量层面。
2.健康者研究结果
DSCT扫描图像显示强化动脉血管与周围组织对比明显,所有研究对象均准确测量。
2.1动脉搏动规律研究
随心脏搏动,主动脉管腔发生周期性变化,升主动脉(AA)最大管径及最小管径出现时相分别为24.02±4.99%,95%CI(22.68%,25.35%),93.5±4.04%,95%CI(92.4%,94.6%)；同层降主动脉(DA)最大管径及最小管径出现时相分别为25.63±4.77%,95%CI(24.35%,26.9%)及96.6±4.58%,95%CI(95.38%,97.83%),晚于升主动脉。最大及最小管径出现时相与心率无明显相关性(AA,r=0.251,p=0.189及r=0.126,p=0.514；DA,r=0.141,p=0.3及r=0.087,p=0.552)。
2.2动脉弹性评估
升主动脉(AA)与降主动脉(DA)相比,动脉直径、横截面积及AoC具有显著差异,%Ao及AoD无明显差异。降主动脉僵硬度与升主动脉不同,但仅在A组(age<40)具有明显统计学差异。
随年龄增加,主动脉在整个心动周期的直径及面积变化程度减小,弹性(%Ao,AoD, AoC)下降,僵硬度(AoSI)增大,年龄与各弹性参数间(%Ao, AoD, AoC及AoSI)的总体相关性在升主动脉为r=-0.747,-0.734,-0.545和0.650,降主动脉为r=-0.690,-0.681,-0.568和0.627(P<0.05or0.01)。不同年龄组及主动脉不同节段动脉弹性的年龄依赖性不同,以A组降主动脉的可扩张度与年龄最为相关(r=-0.828)。
3.动脉瘤患者研究结果
3.1动脉瘤近端及动脉瘤处管腔均随心脏搏动产生舒缩变化。动脉瘤近端面积-时相曲线呈上升-下降趋势,类似于胸段降主动脉；而动脉瘤处面积-时相曲线呈无规律的多次上升-下降趋势。
3.2动脉瘤近端可扩张度为AoDabove=(1.05±0.8) mmHg-1动脉瘤处为AoDaaa=(0.45±0.5)mmHg-1二者之间差异具有统计学意义(p<0.05)。与胸段降主动脉比较,动脉瘤近端AoD亦明显下降((1.05±0.8)vs(2.17±0.58)),二者之间具有显著统计学差异(p<0.01)。
结论
1.作为一种动脉弹性功能评价的新方法,DSCT可以在无需增加额外辐射剂量的前提下,完成动脉形态及功能学的综合评估；
2.动脉管腔随心脏搏动产生规律性变化,心脏收缩期扩张最大,舒张晚期扩张最小,降主动脉的舒缩时相晚于升主动脉；
3.动脉弹性随年龄增加而降低,不同年龄组及主动脉不同节段动脉弹性的年龄依赖性不同；
4.动脉瘤处管壁弹性小于非动脉瘤处及健康者,弹性下降与动脉瘤的发生发展存在相关性。
总之,DSCT结合血管半自动测量软件可准确评估动脉血管的弹性变化,在相关弹性病变早期检测及治疗效果评估方面具有潜在临床应用价值。
Background
Aortic elasticity is defined as the relative temporal change in vessel diameter or cross-sectional area through the cardiac cycle under per unit blood pressure. It depends on the geometrical and mechanical characteristic of the vessel, and is an important functional parameter of the aortic wall. The decrease of arterial elasticity or increase of stiffness is accepted as an independent influencing factor for a series of cardiovascular diseases. During the course of arterial diseases, the decrease of arterial elasticity usually occurred earlier than the morphological and structural changes which can be found by clinical methods. Therefore, aortic elasticity assessments early on may be benefit in preventing and curing arterial and cardiac diseases, and may also play an important role in lowing the incidence and death rate of the cardiovascular diseases.
Now, it is impossible to observe the structural changes of the arterial wall directly and the quantitative assessment of the functional changes of the artery is difficult, thus, a variety of functional parameters are used to reflect the aortic elasticity indirectly. Including pulse pressure, augmentation Index (AI), C1/C2, and pulse wave velocity (PWV) and so on. These functional parameters can be obtained by a particular instrument or varied imaging techniques. Early, ultrasound was firstly used in the assessment of arterial elasticity, especially in the superficial artery. However, the repeatability and consistency is poor affected by the operators. With the continuous advances in imaging technology, MR was used in the evaluation of cardiac function, and then applied to the evaluation of aortic wall structure and function. However, it was not widely accepted because of the long scanning time but low spatial resolution, also the expensive cost.
In the past, CT had been widely used in displaying morphology and anatomical structure of the vascular. Now, it is gradually applied in the evaluation of cardiovascular function. A previous study had reported that it was feasible to evaluate vessel elasticity by using electrocardiographically-gated MDCT through assessing changes of the cross-sectional area during the cardiac cycle. An additional tool is to use, DSCT thereby increasing available temporal resolution to83ms. This permits more accurate vessel measurements at higher heart rates, combined with ECG gating technology, all data during the cardiac cycle can be obtained, which provide a guarantee for the accurate assessment of arterial elasticity. However, there are still no adequate clinical data, the accuracy and clinical value of the technology needs further study.
This was first study to evaluate aortic elasticity in people without relative cardiovascular diseases, all subjects were selected from people undergoing DSCT examination for suspected coronary artery or aortic disease. Based on this, elasticity was also assessed in patients with abdominal artery aneurysms.
Purpose
To gain a new insight into the pulsating property and wall elasticity of the thoracic aorta in people without cardiovascular diseases and people with abdominal artery aneurysms using ECG-gated DSCT, the feasibility and potential clinical value of this technique in arterial function evaluation were discussed, aiming to find an objective and effective method for the comprehensive evaluation of the aortic diseases including morphology and function.
Materials and Methods
1. Experimental study:A silicone tube (inner lumen7.60mm) filled with Iohexol(350mg/ml) and saline(proportion1:32) was examined using DSCT after fixed in a certain radian. Ten different positions,10mm distance from each other, were measured with the vessel measurement prototype software, and the average measurement diameter was compared with the known diameter to verify the accuracy of the software.
2. Study in people without cardiovascular disease:56subjects (male39, female17, average age46±10years) with no cardiovascular disease, selected from2,700people, from Dec.2008to Apr.2010undergoing ECG-gated DSCT examination, were divided into three groups according to their age (A<40years, B40-50years, C>50years). CT data were reconstructed in5%step throughout the RR interval. Diameter and area were measured at the curve of the ascending aorta (AA) and at the same level of the descending aorta (DA), about25±2.5mm above the sinotubular junction. The pulsation and elasticity of the aorta were evaluated, and elastic parameters are%Ao, AoD, AoC and AoSI.
3. Study of abdominal artery aneurysm (AAA):11patients (male9, female2, average age65±9years) with AAA (R>5cm) were examined using ECG-gated DSCT. CT data were reconstructed in5%step throughout the RR interval. Areas were measured at the maximum lumen and AoD was used as the elastic parameter.
Results
1. Accuracy of vessel measurement prototype software:Ten different positions along the silicone tube were measured by vessel measurement prototype software. The extracted average inner diameter was7.64mm. Compared with the known tube diameter of7.60mm the resulting relative error was0.53%. The discordance mainly occurred at the end or start plane of the trace.
2. Results of people without cardiovascular disease The ECG-gated DSCT images showed good contrast between the enhanced vessels and the surrounding tissues for the aortic measurement
2.1Evaluation of pulsation regulation The aortic diameter changes periodically according to the cardiac cycle. The AA achieved the maximum average diameter at an RR interval of24.02±4.99%,95%CI (22.68%,25.35%) and the minimum average diameter at an RR interval of93.5±4.04%,95%CI (92.4%,94.6%) respectively. For the DA, the maximum was at25.63±4.77%,95%CI (24.35%,26.9%), and the minimum was at96.6±4.58%,95%CI (95.38%,97.83%). The phases of the maximum and minimum average diameter were compared in relation to the heart rate and found that there were no significant correlations between the phases and the mean heart rate (for the AA, maximum average diameter phase r=0.251, p=0.189and minimum average diameter phase r=0.126,p=0.514; for the DA, they were r=0.141,p=0.3and r=0.087,p=0.552).
2.2Aortic elasticity assessment There were significant differences between the AA and the DA for the diameter, area change over the cardiac cycle and AoC, whereas no significant difference for %Ao, AoD. The stiffness of the DA was different from that of the AA in all groups, but was only significant in group A.
There was an age-dependent decrease of%Ao, AoD, AoC and increase of AoSI, the correlation coefficients between the age and the elastic parameters (%Ao, AoD, AoC and AoSI) were r=-0.747,-0.734,-0.545and0.650for the AA; the values were-0.690,-0.681,-0.568and0.627for the DA;(P<0.05or0.01). Whereas, the age-dependent trend was different between various age groups and between different elastic parameters, which was more significant in group A with the AoD (r=-0.711for the AA and-0.828for the DA).
3. Results of patients with AAA
3.1Evaluation of pulsation regulation
Both proximal of the aneurysm and the lumen of the aneurysm all changes according to the cardiac cycle. The area-versus-time curve at the proximal of the aneurysm demonstrates up-and-down trend similar to the thoracic descending aorta; while area-versus-time curve demonstrates multiple up-and-down trend without exactly regular pattern.
3.2Aortic elasticity assessment
AoD at the proximal of the aneurysm and the aneurysm portion was (1.05±0.8) mmHg-1and (0.45±0.5) mmHg-1respectively, there were statistical differences between them (p<0.05). Comparing to the thoracic descending aorta, there was significant decrease at the proximal of the aneurysm which was (1.05±0.8) vs (2.17±0.58)(p<0.01).
Conclusions
1. As an new non-invasive method, the morphologic and functional evaluation can be obtained at the same time by using DSCT without additional radiation dose;
2. The lumen of the aorta changes regularly according to the cardiac cycle, the maximum diameter occurred at the systolic time, and the minimum at late of the diastolic time, the time of descending aorta was later than that of the ascending aorta;
3. There was an age-dependent decrease of the elasticity, whereas, the age-dependent trend was different between various age groups and between different elastic parameters;
4. Elasticity at the aneurysm was significantly decreased comparing with the healthy arterial wall and the proximal part of it, the development of aneurysm related closely to the decrease of the elasticity.
In conclusion, the properties of aortic pulsation and wall elasticity could be well shown by ECG-gated DSCT both in healthy people and patient with aneurysm, as a potentially useful noninvasive method, retrospective ECG-gated DSCT can provide valuable functional information of the aorta as well as showing the structural changes.
引文
1. Stefanadis C, Dernellis J, T siamis E, et al. Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischemic heart disease. Eur Heart J, 2000; 21:390-396.
2. Peralta CA, Adeney KL, Shlipak MG, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults:the multi-ethnic study of atherosclerosis. Am J Epidemiol,2010; 171(1):63-71.
3. Van People NM, Grobbee DE, Bots ML, et al. Association between arterial stiffness and atherosclerosis:the Rotterdam Study. Stroke,2001; 32(2):454-460.
4.王宏宇,胡大一.重视动脉僵硬度和大动脉功能检测早期发现血管病变.中国医药导刊,2003；5：337.
5.罗晓佳,陈晓平.血管内皮细胞损伤与高血压.心血管病学进,2010；31(4)：573-577.
6.高英茂.组织学与胚胎学.北京：人民卫生出版社,2001：132.
7.王宏宇.高血压与大动脉缓冲功能.国外医学内科学分册,2000；27(8)：38-341.
8.胡大一,马长生.心脏病学实践：2003-新进展与临床案例.北京：人民卫生出版社,2003：35-42.
9.王宏宇,张维忠,龚兰生,等.高血压病大动脉扩张性与左室肥厚关系的探讨.中华心血管病杂志,2000；28(3)：177-180.
10. Kingwell BA, Waddell TK, Medley TL, et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol, 2002; 40(4):773-779.
11. O'Rourke MF, Staessen JA, Vlachopoulos C, et al. Clinical applications of arterial stiffness; definitions and reference values. AJH,2002; 15:426-444.
12.郭志平,林金秀.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6)：569-573.
13. Lalande A, Khau Van Kien P, Walker PM et al. Compliance and pulse wave velocity assessed by MRI detect early aortic impairment in young patients with mutation of the smooth muscle myosin heavy chain. J Magn Reson Imaging,2008; 28:1180-1187.
14. Gonzalez J, Wood JC, Dorey FJ, et al. Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults. Radiology,2008; 247:465-471
15. Wilson KA, Hoskins PR, Lee AJ, et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study. J Vasc Surg,2000; 31(3): 507-513.
16. Takahashi M, Murata K, Mori M, et al. Evaluation of aortic distensibility using cine MR imaging. Nippon Igaku Hoshasen Gakkai Zasshi,1992; 52 (7):921-927.
17. Matsumoto Y, Honda T, Hamada M, et al. Evaluation of aortic distensibility in patients with coronary artery disease by use of cine magnetic resonance. Angiology, 1996;47(2):149-155.
18. Urchuk SN, Plewes DB. A velocity correlation method for measuring vascular compliance using MR imaging. Journal Of Magnetic Resonance Imaging,1995; 5 (6):628-34
19. Ley S, Mereles D, Puderbach M, et al. Value of MR phase-contrast flow measurements for functional assessment of pulmonary arterial hypertension. European Radiology,2007; 17 (7):1892-7.
20. Ganten M, Boese JM, Leitermann D, et al. Quantification of aortic elasticity: development and experimental validation of a method using computed tomography. Eur Radiol,2005; 15:2506-2512
21. Zhang J, Fletcher JG, Vrtiska TJ, et al. Large-vessel distensibility measurement with electrocardiographically gated multidetector CT:phantom study and initial experience. Radiology,2007; 245(1):258-266.
22. Weber TF, Ganten MK, Bockler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b. Eur Radiol,2009; 19(1):245-253.
1. MacSweeney ST, Powell JT, Greenhalgh RM. Pathogenesis of abdominal aortic aneurysm. Br J Surg.1994; 81:935-941.
2. Lalande A, Khau Van Kien P, Walker PM et al. Compliance and pulse wave velocity assessed by MRI detect early aortic impairment in young patients with mutation of the smooth muscle myosin heavy chain. J Magn Reson Imaging 2008; 28:1180-1187.
3. O'Rourke MF, Staessen JA, Vlachopoulos C et al. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002; 15:426-444.
4. Glasser SP, Arnett DK, McVeigh GE et al. The importance of arterial compliance in cardiovascular drug therapy. J Clin Pharmacol 1998; 38:202-212.
5. Wilson KA, Hoskins PR, Lee AJ et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study. J Vase Surg 2000; 31:507-513.
6. Godia EC, Madhok R, Pittman J et al. Carotid artery distensibility:a reliability study. J Ultrasound Med 2007; 26:1157-1165.
7. Vulliemoz S, Stergiopulos N, Meuli R. Estimation of local aortic elastic properties with MRI. Magn Reson Med 2002; 47:649-654.
8. Malayeri AA, Natori S, Bahrami H et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2008;102:491-496.
9. Cheung N, Sharrett AR, Klein R et al. Aortic distensibility and retinal arteriolar narrowing:the multi-ethnic study of atherosclerosis. Hypertension 2007; 50:617-622.
10. Horiguchi J, Kiguchi M, Fujioka C et al. Radiation dose, image quality, stenosis measurement, and CT densitometry using ECG-triggered coronary 64-MDCT angiography:a phantom study. Am J Roentgenol 2008; 190:315-320.
11.Ganten MK, Krautter U, von Tengg-Kobligk H et al. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography. Eur Radiol 2008; 18:966-973.
12. Zhang J, Fletcher JG, Vrtiska TJ et al. Large-vessel distensibility measurement with electrocardiographically gated multidetector CT:phantom study and initial experience. Radiology 2007; 245:258-266.
13. Flohr TG, McCollough CH, Bruder H et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 2006; 16:256-268.
14. Kingwell BA, Waddell TK, Medley TL et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002; 40(4):773-779.
15.张曦彤,张强,徐克,等.血管内支架移植物置入术治疗Stanford B型主动脉夹层.中国医学影像技术2004；20(6)：925-927.
16.高英茂.组织学与胚胎学[M].北京：人民卫生出版社,2001：132.
17.王宏宇.高血压与大动脉缓冲功能.国外医学内科学分册2000；27(8)：38-341.
18. Nelson AJ, Worthley SG, Cameron JD et al. Cardiovascular magnetic resonance-derived aortic distensibility:validation and observed regional differences in the elderly. J Hypertens 2009; 27:535-542.
19. Rogers WJ, Hu YL, Coast D et al. Age-associated changes in regional aortic pulse wave velocity. J Am Coll Cardiol 2001; 38:1123-1129.
20. McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol 2007; 34:665-671.
21.Ganten M, Krautter U, Hosch Wet al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT Eur Radiol 2007; 17:701-708.
22. Oishi Y, Mizuguchi Y, Miyoshi H et al. A novel approach to assess aortic stiffness related to changes in aging using twodimensional strain imaging. Echocardiography 2008; 9:941-945.
23. Liang YL, Teede H, Kotsopoulos D et al. Non-invasive measurements of arterial structure and function:repeatability, interrelationships and trial ample size Clin Sci 1998; 95:669-679.
24. Schmitt M, Avolio A, Qasem A et al. Basal NO locally modulates human iliac artery function in vivo. Hypertension 2005; 46:227-231.
1. Thompson RW, Geraghty PJ, Lee TK. Abdominal aortic aneurysms:basic mechanisms and clinical implications. Curr Probl Surg,2002,39(2):110-230.
2.刘仁贵,赵纪春.腹主动脉瘤的发病机理及治疗进展.中国普外基础与临床杂志,2008,15(6)：422-425.
3. Petersen E, Wagberg F, Angquist KA. Proteolysis of the abdominal aortic aneurysm wall and the association with ruputure. Eur J Vase Endovasc Surg.2001, 23:153-157.
4. Wilson KA, Lee AJ, Lee AJ, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vase Surg. 2003,37(1):112-117.
5. Moritake K, Handa H, Okumura A,et al. Stiffness of cerebral arteries--its role in the pathogenesis of cerebral aneurysms. Neurol Med Chir (Tokyo).1974,14(1):47-53.
6. Teutelink A, Muhs BE, Vincken KL, et al. Use of dynamic computed tomography to evaluate pre-and postoperative aortic changes in AAA patients undergoing endovascular aneurysm repair. J Endovasc Ther.2007,14(1):44-9.
7. O'Rourke MF, Staessen JA, Vlachopoulos C et al. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002; 15:426-444.
8. Ganten MK, Krautter U, von Tengg-Kobligk H et al. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography. Eur Radiol 2008; 18:966-973.
9. Ganten M, Krautter U, Hosch Wet al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT. Eur Radiol 2007; 17:701-708.
10. Van Herwaarden JA, Muhs BE, Vincken KL. Aortic compliance following EVAR and the influence of different endografts:determination using dynamic MRA. J Endovasc Ther 2006; 13:406-414.
1. Stefanadis C, Dernellis J, T siamis E, et al. Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischemic heart disease[J]. Eur Heart J,2000,21:390-396.
2. Peralta CA, Adeney KL, Shlipak MG, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults:the multi-ethnic study of atherosclerosis [J]. Am J Epidemiol,2010,171(1):63-71.
3. Van People NM, Grobbee DE, Bots ML, et al. Association between arterial stiffness and atherosclerosis:the Rotterdam Study [J].Stroke,2001,32(2):454-460.
4.王宏宇,胡大一.重视动脉僵硬度和大动脉功能检测早期发现血管病变[J].中国医药导刊,2003,5：337.
5.罗晓佳,陈晓平.血管内皮细胞损伤与高血压[J].心血管病学进展,2010,31(4)：573-577.
6.高英茂.组织学与胚胎学[M].北京：人民卫生出版社,2001：132.
7.王宏宇.高血压与大动脉缓冲功能[J].国外医学内科学分册,2000,27(8)：38-341.
8.胡大一,马长生.心脏病学实践：2003-新进展与临床案例[M].北京：人民卫生出版社,2003：35-42.
9. Ganten M, Krautter U, Hosch W, et al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT [J]. Eur Radiol,2007,17:701-708.
10. Nemes A, Lengyel C, Ungi I, et al. Additive effect of diabetes mellitus and hypertension on coronary flow velocity reserve and aortic distensibility in patients with negative coronary angiograms [J]. Diabetes Research And Clinical Practice, 2008,82(2):9-10.
11. Chen XF, Tang LJ, Jiang JJ, et al. Increased levels of lipoprotein (a) in non-smoking aortic dissection patients [J]. Clinical And Experimental Medicine,2008,8 (2):123-127.
12. Malayeri AA, Natori S, Bahrami H, et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]) [J]. Am J Cardiol,2008,2 (4):491-496.
13. Ambring A, Friberg P, Axelsen M, et al. Effects of a Mediterranean-inspired diet on blood lipids, vascular function and oxidative stress in healthy subjects [J]. Clin Sci (Lond),2004,106 (5):519-25.
14. Allaire E, Schneider F, Saucy F, et al. New Insight in Aetiopathogenesis of Aortic Diseases [J]. Eur J Vasc Endovasc Surg,2009,37:531-537
15. Shingu Y, Shiiya N, Ooka T, et al. Augmentation index is elevated in aortic aneurysm and dissection [J]. The Annals Of Thoracic Surgery,2009,87 (5):1373-1377.
16. Katie A. Wilson, Amanda J. Lee, Amanda J. Lee, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg 2003,37:112-7
17.王宏宇,张维忠,龚兰生,等.高血压病大动脉扩张性与左室肥厚关系的探讨.中华心血管病杂志[J].2000,28(3)：177-180.
18. Kingwell BA, Waddell TK, Medley TL, et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease [J]. J Am Coll Cardiol, 2002,40(4):773-779.
19. O'Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney:cause and logic of therapy [J]. Hypertension,2005,46: 200-204.
20. Cheung N, Sharrett AR, Klein R, et al. Aortic Distensibility and Retinal Arteriolar Narrowing [J]. The Multi-Ethnic Study of Atherosclerosis. Hypertension,2007, 50:617-622.
21.郭志平,林金秀.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6)：569-573.
22. Niehols WW, ORourke MF. McDonal's Blood Flow in Arterials:Theoretieal, experimental and clinieal prineiples [M].5th ed. Hodder Arnold,2005:165-191.
23. Gonzalez J, Wood JC, Dorey FJ, et al. Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults [J]. Radiology,2008,247:465-471
24. Wilson KA, Hoskins PR, Lee AJ, et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study [J]. J Vase Surg,2000,31(3): 507-513.
25. Takahashi M, Murata K, Mori M, et al. Evaluation of aortic distensibility using cine MR imaging[J]. Nippon Igaku Hoshasen Gakkai Zasshi,1992,52 (7):921-927.
26. Matsumoto Y; Honda T; Hamada M, et al. Evaluation of aortic distensibility in patients with coronary artery disease by use of cine magnetic resonance [J]. Angiology,1996,47 (2):149-155.
27. Urchuk SN, Plewes DB. A velocity correlation method for measuring vascular compliance using MR imaging [J]. Journal Of Magnetic Resonance Imaging,1995, 5 (6):628-34
28. Ley S, Mereles D,Puderbach M, etal. Value of MR phase-contrast flow measurements for functional assessment of pulmonary arterial hypertension [J]. European Radiology,2007,17 (7):1892-7.
29.张龙江,杨桂芬,包颜明,等MSCT主动脉血流动力学分析及MSCTA的临床应用价值探讨.医学影像学杂志,2004,14(6)：441-444
30. Ganten M, Boese JM, Leitermann D, et al. Quantification of aortic elasticity: development and experimental validation of a method using computed tomography [J]. Eur Radiol,2005,15:2506-2512
31. Philipp Bruners, Andreas H. Mahnken, Christian Knackstedt, et al. Assessment of Global Left and Right Ventricular Function Using Dual-Source Computed Tomography (DSCT) in Comparison to MRI. Invest Radiol,2007,42:756-764
32. Zhang J, Fletcher JG, Vrtiska TJ, et al. Large-Vessel Distensibility Measurement with Electrocardiographically Gated Multidetector CT:Phantom Study and Initial Experience [J]. Radiology,2007,245(1):258-266
33. Weber TF, Ganten MK, Bockler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b [J]. Eur Radiol,2009,19(1):245-253.
34. Oncel D, Oncel G, Tastan A, et al. Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control [J]. American Journal Of Roentgenology,2008,191 (1):56-63.
2. Peralta CA, Adeney KL, Shlipak MG, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults:the multi-ethnic study of atherosclerosis. Am J Epidemiol,2010; 171(1):63-71.
3. Van People NM, Grobbee DE, Bots ML, et al. Association between arterial stiffness and atherosclerosis:the Rotterdam Study. Stroke,2001; 32(2):454-460.
4.王宏宇,胡大一.重视动脉僵硬度和大动脉功能检测早期发现血管病变.中国医药导刊,2003；5：337.
5.罗晓佳,陈晓平.血管内皮细胞损伤与高血压.心血管病学进,2010；31(4)：573-577.
6.高英茂.组织学与胚胎学.北京：人民卫生出版社,2001：132.
7.王宏宇.高血压与大动脉缓冲功能.国外医学内科学分册,2000；27(8)：38-341.
8.胡大一,马长生.心脏病学实践：2003-新进展与临床案例.北京：人民卫生出版社,2003：35-42.
9.王宏宇,张维忠,龚兰生,等.高血压病大动脉扩张性与左室肥厚关系的探讨.中华心血管病杂志,2000；28(3)：177-180.
10. Kingwell BA, Waddell TK, Medley TL, et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol, 2002; 40(4):773-779.
11. O'Rourke MF, Staessen JA, Vlachopoulos C, et al. Clinical applications of arterial stiffness; definitions and reference values. AJH,2002; 15:426-444.
12.郭志平,林金秀.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6)：569-573.
13. Lalande A, Khau Van Kien P, Walker PM et al. Compliance and pulse wave velocity assessed by MRI detect early aortic impairment in young patients with mutation of the smooth muscle myosin heavy chain. J Magn Reson Imaging,2008; 28:1180-1187.
14. Gonzalez J, Wood JC, Dorey FJ, et al. Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults. Radiology,2008; 247:465-471
15. Wilson KA, Hoskins PR, Lee AJ, et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study. J Vasc Surg,2000; 31(3): 507-513.
16. Takahashi M, Murata K, Mori M, et al. Evaluation of aortic distensibility using cine MR imaging. Nippon Igaku Hoshasen Gakkai Zasshi,1992; 52 (7):921-927.
17. Matsumoto Y, Honda T, Hamada M, et al. Evaluation of aortic distensibility in patients with coronary artery disease by use of cine magnetic resonance. Angiology, 1996;47(2):149-155.
18. Urchuk SN, Plewes DB. A velocity correlation method for measuring vascular compliance using MR imaging. Journal Of Magnetic Resonance Imaging,1995; 5 (6):628-34
19. Ley S, Mereles D, Puderbach M, et al. Value of MR phase-contrast flow measurements for functional assessment of pulmonary arterial hypertension. European Radiology,2007; 17 (7):1892-7.
20. Ganten M, Boese JM, Leitermann D, et al. Quantification of aortic elasticity: development and experimental validation of a method using computed tomography. Eur Radiol,2005; 15:2506-2512
21. Zhang J, Fletcher JG, Vrtiska TJ, et al. Large-vessel distensibility measurement with electrocardiographically gated multidetector CT:phantom study and initial experience. Radiology,2007; 245(1):258-266.
22. Weber TF, Ganten MK, Bockler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b. Eur Radiol,2009; 19(1):245-253.
1. MacSweeney ST, Powell JT, Greenhalgh RM. Pathogenesis of abdominal aortic aneurysm. Br J Surg.1994; 81:935-941.
2. Lalande A, Khau Van Kien P, Walker PM et al. Compliance and pulse wave velocity assessed by MRI detect early aortic impairment in young patients with mutation of the smooth muscle myosin heavy chain. J Magn Reson Imaging 2008; 28:1180-1187.
3. O'Rourke MF, Staessen JA, Vlachopoulos C et al. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002; 15:426-444.
4. Glasser SP, Arnett DK, McVeigh GE et al. The importance of arterial compliance in cardiovascular drug therapy. J Clin Pharmacol 1998; 38:202-212.
5. Wilson KA, Hoskins PR, Lee AJ et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study. J Vase Surg 2000; 31:507-513.
6. Godia EC, Madhok R, Pittman J et al. Carotid artery distensibility:a reliability study. J Ultrasound Med 2007; 26:1157-1165.
7. Vulliemoz S, Stergiopulos N, Meuli R. Estimation of local aortic elastic properties with MRI. Magn Reson Med 2002; 47:649-654.
8. Malayeri AA, Natori S, Bahrami H et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2008;102:491-496.
9. Cheung N, Sharrett AR, Klein R et al. Aortic distensibility and retinal arteriolar narrowing:the multi-ethnic study of atherosclerosis. Hypertension 2007; 50:617-622.
10. Horiguchi J, Kiguchi M, Fujioka C et al. Radiation dose, image quality, stenosis measurement, and CT densitometry using ECG-triggered coronary 64-MDCT angiography:a phantom study. Am J Roentgenol 2008; 190:315-320.
11.Ganten MK, Krautter U, von Tengg-Kobligk H et al. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography. Eur Radiol 2008; 18:966-973.
12. Zhang J, Fletcher JG, Vrtiska TJ et al. Large-vessel distensibility measurement with electrocardiographically gated multidetector CT:phantom study and initial experience. Radiology 2007; 245:258-266.
13. Flohr TG, McCollough CH, Bruder H et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 2006; 16:256-268.
14. Kingwell BA, Waddell TK, Medley TL et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002; 40(4):773-779.
15.张曦彤,张强,徐克,等.血管内支架移植物置入术治疗Stanford B型主动脉夹层.中国医学影像技术2004；20(6)：925-927.
16.高英茂.组织学与胚胎学[M].北京：人民卫生出版社,2001：132.
17.王宏宇.高血压与大动脉缓冲功能.国外医学内科学分册2000；27(8)：38-341.
18. Nelson AJ, Worthley SG, Cameron JD et al. Cardiovascular magnetic resonance-derived aortic distensibility:validation and observed regional differences in the elderly. J Hypertens 2009; 27:535-542.
19. Rogers WJ, Hu YL, Coast D et al. Age-associated changes in regional aortic pulse wave velocity. J Am Coll Cardiol 2001; 38:1123-1129.
20. McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol 2007; 34:665-671.
21.Ganten M, Krautter U, Hosch Wet al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT Eur Radiol 2007; 17:701-708.
22. Oishi Y, Mizuguchi Y, Miyoshi H et al. A novel approach to assess aortic stiffness related to changes in aging using twodimensional strain imaging. Echocardiography 2008; 9:941-945.
23. Liang YL, Teede H, Kotsopoulos D et al. Non-invasive measurements of arterial structure and function:repeatability, interrelationships and trial ample size Clin Sci 1998; 95:669-679.
24. Schmitt M, Avolio A, Qasem A et al. Basal NO locally modulates human iliac artery function in vivo. Hypertension 2005; 46:227-231.
1. Thompson RW, Geraghty PJ, Lee TK. Abdominal aortic aneurysms:basic mechanisms and clinical implications. Curr Probl Surg,2002,39(2):110-230.
2.刘仁贵,赵纪春.腹主动脉瘤的发病机理及治疗进展.中国普外基础与临床杂志,2008,15(6)：422-425.
3. Petersen E, Wagberg F, Angquist KA. Proteolysis of the abdominal aortic aneurysm wall and the association with ruputure. Eur J Vase Endovasc Surg.2001, 23:153-157.
4. Wilson KA, Lee AJ, Lee AJ, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vase Surg. 2003,37(1):112-117.
5. Moritake K, Handa H, Okumura A,et al. Stiffness of cerebral arteries--its role in the pathogenesis of cerebral aneurysms. Neurol Med Chir (Tokyo).1974,14(1):47-53.
6. Teutelink A, Muhs BE, Vincken KL, et al. Use of dynamic computed tomography to evaluate pre-and postoperative aortic changes in AAA patients undergoing endovascular aneurysm repair. J Endovasc Ther.2007,14(1):44-9.
7. O'Rourke MF, Staessen JA, Vlachopoulos C et al. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002; 15:426-444.
8. Ganten MK, Krautter U, von Tengg-Kobligk H et al. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography. Eur Radiol 2008; 18:966-973.
9. Ganten M, Krautter U, Hosch Wet al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT. Eur Radiol 2007; 17:701-708.
10. Van Herwaarden JA, Muhs BE, Vincken KL. Aortic compliance following EVAR and the influence of different endografts:determination using dynamic MRA. J Endovasc Ther 2006; 13:406-414.
1. Stefanadis C, Dernellis J, T siamis E, et al. Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischemic heart disease[J]. Eur Heart J,2000,21:390-396.
2. Peralta CA, Adeney KL, Shlipak MG, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults:the multi-ethnic study of atherosclerosis [J]. Am J Epidemiol,2010,171(1):63-71.
3. Van People NM, Grobbee DE, Bots ML, et al. Association between arterial stiffness and atherosclerosis:the Rotterdam Study [J].Stroke,2001,32(2):454-460.
4.王宏宇,胡大一.重视动脉僵硬度和大动脉功能检测早期发现血管病变[J].中国医药导刊,2003,5：337.
5.罗晓佳,陈晓平.血管内皮细胞损伤与高血压[J].心血管病学进展,2010,31(4)：573-577.
6.高英茂.组织学与胚胎学[M].北京：人民卫生出版社,2001：132.
7.王宏宇.高血压与大动脉缓冲功能[J].国外医学内科学分册,2000,27(8)：38-341.
8.胡大一,马长生.心脏病学实践：2003-新进展与临床案例[M].北京：人民卫生出版社,2003：35-42.
9. Ganten M, Krautter U, Hosch W, et al. Age related changes of human aortic distensibility:evaluation with ECG-gated CT [J]. Eur Radiol,2007,17:701-708.
10. Nemes A, Lengyel C, Ungi I, et al. Additive effect of diabetes mellitus and hypertension on coronary flow velocity reserve and aortic distensibility in patients with negative coronary angiograms [J]. Diabetes Research And Clinical Practice, 2008,82(2):9-10.
11. Chen XF, Tang LJ, Jiang JJ, et al. Increased levels of lipoprotein (a) in non-smoking aortic dissection patients [J]. Clinical And Experimental Medicine,2008,8 (2):123-127.
12. Malayeri AA, Natori S, Bahrami H, et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]) [J]. Am J Cardiol,2008,2 (4):491-496.
13. Ambring A, Friberg P, Axelsen M, et al. Effects of a Mediterranean-inspired diet on blood lipids, vascular function and oxidative stress in healthy subjects [J]. Clin Sci (Lond),2004,106 (5):519-25.
14. Allaire E, Schneider F, Saucy F, et al. New Insight in Aetiopathogenesis of Aortic Diseases [J]. Eur J Vasc Endovasc Surg,2009,37:531-537
15. Shingu Y, Shiiya N, Ooka T, et al. Augmentation index is elevated in aortic aneurysm and dissection [J]. The Annals Of Thoracic Surgery,2009,87 (5):1373-1377.
16. Katie A. Wilson, Amanda J. Lee, Amanda J. Lee, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg 2003,37:112-7
17.王宏宇,张维忠,龚兰生,等.高血压病大动脉扩张性与左室肥厚关系的探讨.中华心血管病杂志[J].2000,28(3)：177-180.
18. Kingwell BA, Waddell TK, Medley TL, et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease [J]. J Am Coll Cardiol, 2002,40(4):773-779.
19. O'Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney:cause and logic of therapy [J]. Hypertension,2005,46: 200-204.
20. Cheung N, Sharrett AR, Klein R, et al. Aortic Distensibility and Retinal Arteriolar Narrowing [J]. The Multi-Ethnic Study of Atherosclerosis. Hypertension,2007, 50:617-622.
21.郭志平,林金秀.动脉功能无创性检测的常用指标.中华高血压杂志,2009,17(6)：569-573.
22. Niehols WW, ORourke MF. McDonal's Blood Flow in Arterials:Theoretieal, experimental and clinieal prineiples [M].5th ed. Hodder Arnold,2005:165-191.
23. Gonzalez J, Wood JC, Dorey FJ, et al. Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults [J]. Radiology,2008,247:465-471
24. Wilson KA, Hoskins PR, Lee AJ, et al. Ultrasonic measurement of abdominal aortic aneurysm wall compliance:a reproducibility study [J]. J Vase Surg,2000,31(3): 507-513.
25. Takahashi M, Murata K, Mori M, et al. Evaluation of aortic distensibility using cine MR imaging[J]. Nippon Igaku Hoshasen Gakkai Zasshi,1992,52 (7):921-927.
26. Matsumoto Y; Honda T; Hamada M, et al. Evaluation of aortic distensibility in patients with coronary artery disease by use of cine magnetic resonance [J]. Angiology,1996,47 (2):149-155.
27. Urchuk SN, Plewes DB. A velocity correlation method for measuring vascular compliance using MR imaging [J]. Journal Of Magnetic Resonance Imaging,1995, 5 (6):628-34
28. Ley S, Mereles D,Puderbach M, etal. Value of MR phase-contrast flow measurements for functional assessment of pulmonary arterial hypertension [J]. European Radiology,2007,17 (7):1892-7.
29.张龙江,杨桂芬,包颜明,等MSCT主动脉血流动力学分析及MSCTA的临床应用价值探讨.医学影像学杂志,2004,14(6)：441-444
30. Ganten M, Boese JM, Leitermann D, et al. Quantification of aortic elasticity: development and experimental validation of a method using computed tomography [J]. Eur Radiol,2005,15:2506-2512
31. Philipp Bruners, Andreas H. Mahnken, Christian Knackstedt, et al. Assessment of Global Left and Right Ventricular Function Using Dual-Source Computed Tomography (DSCT) in Comparison to MRI. Invest Radiol,2007,42:756-764
32. Zhang J, Fletcher JG, Vrtiska TJ, et al. Large-Vessel Distensibility Measurement with Electrocardiographically Gated Multidetector CT:Phantom Study and Initial Experience [J]. Radiology,2007,245(1):258-266
33. Weber TF, Ganten MK, Bockler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b [J]. Eur Radiol,2009,19(1):245-253.
34. Oncel D, Oncel G, Tastan A, et al. Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control [J]. American Journal Of Roentgenology,2008,191 (1):56-63.