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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (09) : 821 -826. doi: 10.3877/cma.j.issn.1672-6448.2020.09.002

所属专题： 文献；

腹部超声影像学

高帧频超声造影在腹主动脉瘤EVAR术后Ⅱ型内漏评估中的应用
文晓蓉1, 罗燕1,†(), 黄才蓉1, 黄河1, 付光明2, 邹凤芬1   
  1. 1. 610041　成都，四川大学华西医院超声医学科
    2. 518055　深圳迈瑞生物医疗电子股份有限公司
  • 收稿日期:2020-07-10 出版日期:2020-09-01
  • 通信作者: 罗燕
  • 基金资助:
    四川省科技厅课题(18ZDYF2198)

Application of high-frame-rate contrast-enhanced ultrasound in evaluation of type II endoleak after endovascular aneurysm repair

Xiaorong Wen1, Yan Luo1,†(), Cairong Huang1, He Huang1, Guangming Fu2, Fengfen Zou1   

  1. 1. Department of Ultrasound Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
    2. Shenzhen Mindray Bio-medical Electronics Co, Ltd., Shenzhen 518055, China
  • Received:2020-07-10 Published:2020-09-01
  • Corresponding author: Yan Luo
  • About author:
    Corresponding author: Luo Yan, Email:
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文晓蓉, 罗燕, 黄才蓉, 黄河, 付光明, 邹凤芬. 高帧频超声造影在腹主动脉瘤EVAR术后Ⅱ型内漏评估中的应用[J]. 中华医学超声杂志（电子版）, 2020, 17(09): 821-826.

Xiaorong Wen, Yan Luo, Cairong Huang, He Huang, Guangming Fu, Fengfen Zou. Application of high-frame-rate contrast-enhanced ultrasound in evaluation of type II endoleak after endovascular aneurysm repair[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 821-826.

目的

探讨高帧频超声造影（H-CEUS）对腹主动脉瘤血管腔内覆膜支架植入术（EVAR）术后Ⅱ型内漏来源动脉的显示价值。

方法

收集四川大学华西医院2020年5月至8月的EVAR术后患者9例，所有的患者常规超声均怀疑Ⅱ型内漏。使用迈瑞Resona 7超声仪，分别用常规超声、传统超声造影（CEUS）及H-CEUS进行评估，观察有无内漏并寻找内漏的来源动脉，测量血流速度。由1名有经验的超声医师做传统的CEUS和H-CEUS检查，观察支架及瘤腔显影时间，计算显影时间差及寻找来源动脉。留存动态及静态图像，由另外2名有经验的超声医师回顾信息，根据2种造影来源动脉的可辨识度及图像质量情况进行评分。采用配对样本t检验比较入瘤腔方向峰值流速和出瘤腔方向最大流速的差异；采用非参数检验的Wilcoxon符号秩检验比较传统CEUS对来源动脉成像质量评分与H-CEUS成像质量评分的差异。

结果

瘤体大小平均（5.2±1.1）cm，并且所有患者瘤体无明显长大。1例患者术后3个月时内漏自愈。9例患者中1例患者CEUS及H-CEUS未见内漏，即常规超声检查呈假阳性，8例患者常规超声检查发现的内漏经CEUS证实。8例患者内漏均为Ⅱ型内漏，其中3例来源于单支动脉，余5例为2支动脉以上的内漏。内漏来源于肠系膜下动脉和（或）腰动脉。彩色多普勒超声发现13支动脉来源动脉，但CEUS发现15支来源动脉。内漏来源动脉图像质量评分中位数：传统CEUS为1.0分，H-CEUS为3.0分，两者比较差异具有统计学意义（Z=-3.035，P=0.002）。

结论

在EVAR术后Ⅱ型内漏的诊断中，H-CEUS较传统CEUS能更能清晰地显示来源动脉。

关键词: 腹主动脉瘤, 腔内覆膜支架植入术, 高帧频超声造影
Objective

To investigate the role of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in displaying the source artery of type Ⅱ endoleak after endovascular aneurysm repair (EVAR).

Methods

A total of nine patients after EVAR were included in the study at our hospital from the end of May to the beginning of August 2020. All of the patients were suspected of having type Ⅱ endoleak according to conventional ultrasound. The patients were evaluated by conventional ultrasound, conventional contrast-enhanced ultrasound (CEUS), and H-CEUS by using Mindray Resona 7 ultrasound instrument to observe whether there was endoleak and to find the source artery of endoleak. Traditional CEUS examination and H-CEUS were performed by an experienced physician to observe the time to display the stent and aneurysm cavity to calculate the time difference and to find the source artery. Dynamic and static images were preserved and reviewed by two other experienced ultrasound physicians, and scored according to the identifiability and image quality of the two angiographic sources. Paired sample t test was used to compare the difference of the peak velocity in the direction of inflow and the maximum velocity in the direction of outflow. Wilcoxon signed-rank test was used to compare the difference of imaging quality score of source arterial imaging by conventional CEUS with that of H-CEUS.

Results

The average size of the abdominal aortic aneurysm was (5.2±1.1) cm, and there was no obvious aneurysm growth in all patients. One patient recovered 3 months after EVAR. There was no endoleak in one of the nine patients, which was false positive finding by color Doppler ultrasound. Eight cases of endoleak found by color Doppler ultrasound were confirmed by CEUS. Eight cases were diagnosed with type Ⅱ endoleak, of which three were from a single artery, and the remaining five were from more than two arteries. The endoleak originated from the inferior mesenteric artery (IMA) and/or lumbar artery (LA). Color Doppler ultrasound showed 13 arteries, but CEUS found 15 arteries. The median of image quality score of endoleak source artery was 1.0 for conventional CEUS and 3.0 for H-CEUS, and there was a significant difference between them (Z=-3.035, P=0.002).

Conclusion

In the diagnosis of type Ⅱ endoleak after EVAR, H-CEUS can more clearly show the source artery than the traditional CEUS.

Key words: Abdominal aortic aneurysm, Endovascular stent implantation, High-frame-rate contrast-enhanced ultrasound
表1 9例腹主动脉瘤患者一般信息及血管腔内覆膜支架植入术后常规超声检查
病例序号 年龄（岁） 性别 瘤体体大小（cm） 随访时间（月） 内漏来源 入瘤峰值流速（cm/s） 出瘤最大流速（cm/s）
1 50 女 3.1 1 LA 28.8 16.3
2 54 女 4.5 24 LA×2b 196.0 77.5
3 65 男 4.8 1 IMA 87.0 30.9
4 67 男 4.8 3 LA 48.0 32.4
5 77 男 6.5 25 IMA 44.0 39.1
LA 61.4 23.2
6 75 男 7.0 36 IMA 117.0 76.2
LA 71.7 36.6
7 66 男 4.9 12 IMA 78.7 46.3
LA 56.1 26.7
8 70 女 5.4 3 IMA 14.9a 34.7a
LA 43.2 19.2
9 61 男 5.5 1 - - -
图1~5 患者女性，50岁，腹主动脉瘤直径3.0 cm，Ⅱ型内漏，来自腰动脉。灰阶超声显示腹主动脉瘤瘤腔内分叉型支架，支架周围可见弱回声血栓样物质充填（图1）；彩色多普勒血流成像显示支架及支架外的瘤腔内可见血流信号（箭头），提示存在内漏，根据位置考虑来自腰动脉，但未能直接显示腰动脉（图2）；脉冲多普勒超声检测到双期双向血流频谱，入瘤腔峰值流速：27.9 cm/s，出瘤腔最大流速：16.3 cm/s（图3）。传统CEUS帧频11 fbs，1分30秒截图中显示瘤腔内有造影剂显影，但腰动脉边界模糊（图4）；H-CEUS帧频37 fbs，1分40秒截图显示腰动脉清晰显影（图5）
表2 9例腹主动脉瘤患者传统造影与高帧频造影结果比较
病例序号 瘤腔延迟显影时间（s） CEUS判断的内漏来源 传统CEUS对来源动脉成像质量评分（分） H-CEUS成像质量评分（分）
1 6.0 LA 1 3
2 4.0 LA1 1 3
? ? LA2 1 3
3 11.0 IMA 2 3
4 5.0 LA 1 2
5 6.0 IMA 1 1
LA1 1 2
LA2 1 2
6 4.0 IMA 2 3
LA1 3 3
LA2 3 3
7 5.0 IMA 3 3
LA 2 3
8 6.0 IMA 2 3
LA 1 3
9 - - - -
1
汪忠镐．血管淋巴管外科学 [M]．2版．北京：人民卫生出版社，2014：182-183．
2
Drelich-Zbroja A, Sojka M, Kuczyńska M, et al. Diagnostic imaging in patients after endovascular aortic aneurysm repair with special focus on ultrasound contrast agents [J]. Pol Arch Intern Med, 2019, 129(2): 80-87.
3
宝莱克(美)．血管超声经典教程 [M]．温朝阳，童一砂，译．6版．北京：人民军医出版社，2015：326-335．
4
Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: Summary of opinions expressed at an international conference [J]. J Vasc Surg, 2002, 35(5): 1029-1035.
5
Hellinger JC. Endovascular repair of thoracic and abdominal aortic aneurysms: pre- and postprocedural imaging [J]. Tech Vasc Interv Radiol, 2005, 8(1): 2-15.
6
Nadia Jawad, Pamela Parker, Raghuram Lakshminarayan. The role of contrast-enhanced ultrasound imaging in the follow-up of patients post-endovascular aneurysm repair [J]. Ultrasound, 2016, 24(1): 50-59.
7
Heikkinen MA, Arko FR, Zarins CK. What is the significance of endole- aks and endotension [J]. Surg Clin North Am, 2004, 84: 1337-1352.
8
Chaikof EL, Blankensteijn JD, Harris PL, et al. Reporting stan-dards for endovascular aortic aneurysm repair [J]. J Vasc Surg, 2002, 35(5): 1048-1060.
9
汪忠镐，舒畅．血管外科学临床解剖学 [M]．2版．济南：山东科学技术出版社，2020：191-196．
10
Cantisani V, Ricci P, Grazhdani H, et al. Prospective comparative analysis of colour-Doppler ultrasound, contrast-enhanced ultrasound, computed tomography and magnetic resonance in detecting endoleak after endovascular abdominal aortic aneurysm repair [J]. Eur J Vasc Endovasc Surg, 2011, 41(2): 186-192.
11
郭发才，代远斌，徐强．EVAR术后II型内漏相关动脉的应用解剖学研究 [J]．中国临床解剖学杂志，2012，30(1)：17-21．
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