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

doi:10.3877/cma.j.issn.2095-6568.2026.01.007

Abstract

Abstract:

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.

Key words: Aortic diseases, Type B aortic dissection, Hemodynamics, Computational fluid dynamics, 4D flow magnetic resonance imaging, Non-invasive imaging assessment

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

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References 49

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评估时期	作者	指标	研究内容	研究结果与意义
术前指导	Aghilinejad等^［15］	假腔内RPP、RFI等	支架长度选择	选用中等长度的支架，有利于TEVAR术后夹层愈合
	Armour等^［16］	SG-FRT、假腔流速、TAWSS等	术前评估手术部位	TEVAR手术支架移植物着陆区应确保足够的SG-FRT距离
	Liu等^［17］	流速流线、壁压和WSS等	指导双入口撕裂夹层支架植入	双入口撕裂的TBAD患者，封闭近端（靠近心脏的）入口撕裂口有助于夹层愈合，术后仍需密切监测
术后评估	Wang等^［23］	血流速度、WSS分布及血栓-血腔界面变化等	指导PFLT患者TEVAR术后再干预决策	前述指标可定量监测PFLT演变，再破口封闭措施有利于促进FL进一步血栓形成
	Wang等^［24］	RRT、TAWSS、RFF等	术后疗效监测，预警主动脉扩张及dSINE失稳风险	TEVAR术后，dSINE稳定状态与RRT及TAWSS显著相关；RFF升高伴收缩期顺行血流增强，可能预示主动脉扩张及dSINE失稳风险
	Xu等^［25］	血流动力学定量预后指标——FBP	横向比较不同患者术后稳定状态的FBP	TEVAR术后，FBP向远端移动，离开破口剥离区域的患者，表现出更高的功能改善
	Li等^［26］	血流动力学定量预后指标——FBP	纵向评估FBP的动态变化过程	若FBP持续向远端移动，提示假腔持续灌注和疾病进展的风险，尤其在再入口未封闭的情况下

评估时期	作者	指标	研究内容	研究结果与意义
术前指导	Aghilinejad等^［15］	假腔内RPP、RFI等	支架长度选择	选用中等长度的支架，有利于TEVAR术后夹层愈合
	Armour等^［16］	SG-FRT、假腔流速、TAWSS等	术前评估手术部位	TEVAR手术支架移植物着陆区应确保足够的SG-FRT距离
	Liu等^［17］	流速流线、壁压和WSS等	指导双入口撕裂夹层支架植入	双入口撕裂的TBAD患者，封闭近端（靠近心脏的）入口撕裂口有助于夹层愈合，术后仍需密切监测
术后评估	Wang等^［23］	血流速度、WSS分布及血栓-血腔界面变化等	指导PFLT患者TEVAR术后再干预决策	前述指标可定量监测PFLT演变，再破口封闭措施有利于促进FL进一步血栓形成
	Wang等^［24］	RRT、TAWSS、RFF等	术后疗效监测，预警主动脉扩张及dSINE失稳风险	TEVAR术后，dSINE稳定状态与RRT及TAWSS显著相关；RFF升高伴收缩期顺行血流增强，可能预示主动脉扩张及dSINE失稳风险
	Xu等^［25］	血流动力学定量预后指标——FBP	横向比较不同患者术后稳定状态的FBP	TEVAR术后，FBP向远端移动，离开破口剥离区域的患者，表现出更高的功能改善
	Li等^［26］	血流动力学定量预后指标——FBP	纵向评估FBP的动态变化过程	若FBP持续向远端移动，提示假腔持续灌注和疾病进展的风险，尤其在再入口未封闭的情况下

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	预测主动脉生长预测主动脉生长	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
定量流体指标	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
假腔血栓形成相关指标	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

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	预测主动脉生长预测主动脉生长	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
定量流体指标	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
假腔血栓形成相关指标	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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