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中华心脏与心律电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 41 -47. doi: 10.3877/cma.j.issn.2095-6568.2026.01.007

综述

B型主动脉夹层无创影像评估新进展:血流动力学应用
刘安妮, 王怡宁()   
  1. 100730 北京,中国医学科学院 北京协和医学院 北京协和医院放射科
  • 收稿日期:2025-04-18 出版日期:2026-03-25
  • 通信作者: 王怡宁
  • 基金资助:
    北京市自然科学基金重点研究专题项目(Z210013)

New progress in non-invasive imaging evaluation of type B aortic dissection: hemodynamic applications

Anni Liu, Yining Wang()   

  1. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2025-04-18 Published:2026-03-25
  • Corresponding author: Yining Wang
引用本文:

刘安妮, 王怡宁. B型主动脉夹层无创影像评估新进展:血流动力学应用[J/OL]. 中华心脏与心律电子杂志, 2026, 14(01): 41-47.

Anni Liu, Yining Wang. New progress in non-invasive imaging evaluation of type B aortic dissection: hemodynamic applications[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2026, 14(01): 41-47.

B型主动脉夹层(TBAD)占所有主动脉夹层的25%~40%,具有较高的发病率和死亡率。与A型主动脉夹层需要紧急手术处理不同,TBAD的治疗更依赖影像风险分层评估。当前TBAD以药物治疗为基础治疗,是否进行手术干预尚存争议。血流动力学技术的发展,有望结合形态学和血流动力学影像评估,实现更完善的TBAD患者风险分层和预后评估。基于此,本文就两种新兴血流动力学技术在TBAD无创影像评估的应用新进展作简要综述。

Type B aortic dissection (TBAD) accounts for 25%-40% of all aortic dissection, with high morbidity and mortality. Unlike type A aortic dissection which requires emergent surgery, the treatment of TBAD relies more on imaging risk stratification assessment. The current basic treatment of TBAD is drug therapy, and there is still controversy over the use of surgical interventions. With the development of hemodynamic technology, it is expected to combine morphological and hemodynamic imaging characterizations to achieve more comprehensive risk stratification and prognosis assessment of TBAD patients. Based on this, the article briefly reviews the new progress in the application of two emerging hemodynamic techniques for non-invasive imaging evaluation of type B aortic dissection.

表1 计算流体力学在主动脉夹层手术决策与预后评估的运用
表2 四维血流磁共振成像在主动脉夹层预后评估的应用
指标类型 作者 指标 研究内容 研究结果与意义
压力指标 Burris等30 FLEF等

预测主动脉生长

预测主动脉生长

FLEF独立预测主动脉生长,无创评估假腔压力,改善TBAD患者风险评估
Marlevi等31 FLEF和FL ΔPmax等 CMR衍生的FLEF和FL ΔPmax,与主动脉扩大分别呈正相关与负相关,有助于区分主动脉夹层进展情况及并发症风险高低
Allen等32 FLEF等 预测主动脉相关不良结果 定量分析TBAD患者主要破口撕裂处的血流动力学特征,有潜力动态监测血流变化、识别高危患者
定量流体指标 Jarvis等34 三维定量血流动力学参数图——真假腔内的前向/逆向流速、血流停滞程度和流体动能 识别易发并发症高危患者 参数图能够直观定量可视化真假腔血流特征,识别易发生并发症的高风险个体,具有潜在的预后评估价值
Engel等35 血流动力学参数随时间的变化量(Δ) 动态预后分层识别再干预需求TBAD患者 动态血流参数结合TBAD的亚型分组,从机制角度揭示不同亚型血流特征差异,有潜能鉴别具有再干预需求的TBAD患者

假腔血栓形成

相关指标

Ruiz-Muñoz等36 IRF和PWV 反映PFLT血流扰动特征 有助于识别假腔持续扩张和不良事件风险较高的患者
Ruiz-Muñoz等37 假腔KE、血流进入比率等 提示假腔血栓的存在与程度,识别PFLT患者 提前预警不良主动脉扩张风险,为TEVAR术后个体化监测与再干预策略提供支持
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