头臂型Takayasu’s动脉炎:评价多层螺旋CTA诊断价值  

The MDCTA Findings in Takayasu's Arteritis Involving Carotid Arteries

作　　者：周建军[1] 周康荣[1] 陈祖望[1] 曾蒙苏[1] 严福华[1] 王建华[1] 

机构地区：[1]复旦大学附属中山医院放射科

出　　处：《临床放射学杂志》2008年第9期1198-1202,共5页Journal of Clinical Radiology

摘　　要：目的分析头臂型Takayasu’s动脉炎弓上分支及颈动脉多层螺旋cT血管成像（MDCTA）表现，探讨MDCTA在头臂型大动脉炎诊断中的价值。资料与方法临床已确诊头臂型Takayasu’s动脉炎21例，行MDC．TA，范围从主动脉弓到颅底颈动脉，注射流率4ml／s，有效层厚为1．3mm，获得的容积数据采用最大密度投影重组。将头臂型Takayasu’s动脉炎弓上分支及颈动脉分段评价，采用NASCET标准判断颈动脉的狭窄程度。结果21例大动脉炎中，左侧弓上分支及颈动脉段正常或轻度狭窄31段，中度狭窄32段，重度狭窄45段，闭塞16段，瘤样扩张2段。累及右侧依次为60，26，29，8，3段。弓上分支及颈动脉近心段病变发病率为57．1％，中远段为61．9％。动脉管壁厚度为1．2—4．1mm，平均3．2mm。其他征象包括管壁模糊47段，管壁环状强化35段，管壁不均匀强化23段，双环征12段。结论头臂型Takayasu’s动脉炎弓上分支及颈动脉狭窄比闭塞多见，闭塞比动脉瘤样扩张多见。其中，左侧颈总动脉受累的概率高于右侧，狭窄程度重于右侧。原始横断面图像可显示大动脉炎特有的管壁改变，准确显示病变范围以及判断病变是否活动。Objective To explore the MDCTA findings of Takayasu＇s arteritis involving carotid arteries and evaluating its clinical value. Materials and Methods 21 patients with Takayasu＇s arteritis mainly localized in carotid arteries con- firmed by clinical materials underwent MDCTA with injection rates of 4ml/s and the collimation of 1.3mm, the acquired vol- ume data were reconstructed with the Maximum Intensity Projection（MIP） and Volume Rendering（VR）. General evaluation was based on the morphology of different parts of carotid artery and axial images. The degree of stenosis of vessel was evalu- ated according to NASCET standards. Results MDCTA showed 31,32,45 segments of normal or slight degree,mild de- gree,high degree of stenosis and 16 segments occlusions respectively,2 segments dilated artery on the left side vessels, and 60,26,29,8,3 respectively on the right side. The involved rates of the near aortic arch segments and the far segments were 57.1% ,61.9% respectively. The wall thickness of the involved vessel was 1.2mm - 4. lmm, with a mean thickness of 3.2mm. MDCT showed wall bluring in 47 segments, wall ring enhancement in 35 segments, wall irregular enhancement in 23 segments,double ring sign in 12 segments. Conclusion The stenosis of Takayasu＇s arteritis involving carotid arteries is more common than occusion,the dilation is rarely seen. Left carotid arteries are more involved and more severer than that of the right side. CT axial image shows peculiar changes in the carotid artery wall as extent and evolution of the disease.

关 键 词：Takayasu’s动脉炎 颈动脉 体层摄影术 x线计算机诊断 

分 类 号：R543[医药卫生—心血管疾病]