64层螺旋CT血管成像对急性主动脉综合征的评价  

Evaluation of acute aortic syndrome by 64-slice spiral CT angiography

作　　者：胡茂清[1] 龙晚生[1] 龙昉[1] 张朝桐[1] 金志发[1] 兰勇[1] 崔恩铭[1] 梁启堂[1] 陈相猛[1] 

机构地区：[1]江门市中心医院放射科,广东江门529030

出　　处：《实用放射学杂志》2013年第4期552-556,564,共6页Journal of Practical Radiology

摘　　要：目的探讨64层螺旋CT血管成像对急性主动脉综合征的诊断价值。方法对197例急性胸痛患者进行CT平扫及增强扫描，利用图像后处理软件进行图像重组，分析其CT表现。结果197例急性主动脉综合征患者中，主动脉夹层101例，其中SandfordA型33例，B型68例，均见真假双腔征和撕脱内膜片，累及范围及并发症清晰显示；壁内血肿23例，表现沿主动脉壁新月形或环形无强化高密度影，12例可见内膜钙化点移位；穿透性粥样硬化性溃疡69例，表现主动脉壁内有对比剂充盈的龛影，47例伴壁内血肿。胸部主动脉瘤破裂伴纵隔血肿4例，动脉瘤位于主动脉弓3例，1例位于降主动脉。间接征象包括主动脉壁钙化斑块、主动脉扩张、胸腔积液、心包积液或积血等。结论虽然主动脉夹层、壁内血肿、穿透性粥样硬化性溃疡和主动脉瘤破裂的临床症状相似，但各有典型的影像学表现。MSCTA是一种快速无创性检查方法，对急性主动脉综合征的诊断及鉴别诊断有重要价值。Objective To evaluate the value of 64-slice spiral CT angiography in diagnosing acute aortic syndrome（AAS）. Meth- ods One hundred and ninety-seven patients with acute chest pain underwent unenhanced and contrast-enhanced CT scanning, aorta was reconstructed on workstation with image processing software,and the CT fingdings were analysed. Results Among the 197 AAS patients, there were aortic dissection（AD） in 101 cases, including type A of Stanford in 33 cases and type B 68 cases, the true and false lumen sign, avulsed intimal flap were seen on MSCT, and the involving range and complications displayed clearly in all ca- ses. Intramural hematoma（IMH）were showed in 23 cases, with features of crescent or circular shaped non-enhanced high density shadows around the aorta, intimal calcification spots shifted were seen in 12 cases. Penetrating atherosclerotic ulcer（PAU） were found in 69 cases, which showed niche filling with contrast medium and protruding the lumen of aorta, and accompanied IMH in 47 cases. Rupture of aortic aneurysm （RAA） with mediastinal hematoma was seen in 4 cases, RAAs located in aortic arch in 3 cases, in descending aorta in 1 case. The indirect signs included calcification of the aortic wall, dilatation of aorta, pleural effusion, pericar- dial effusion or hemopericardium, etc. Conclusion Although the clinical symptoms of AD, IMH, PAU and RAA are similar, but each with typical imaging findings on MSCTA, which is a fast and non-invasive method, and can provide important information for the diagnosis of AAS.

关 键 词：急性主动脉综合征 主动脉夹层 壁内血肿 穿透性动脉硬化性溃疡 胸主动脉瘤 计算机体层成像 

分 类 号：R543.1[医药卫生—心血管疾病] R814.42[医药卫生—内科学]