儿童多发性大动脉炎64层螺旋CT血管成像临床诊断价值初探  

Preliminary study of the clinical value of 64-slice spiral CT angiography in the diagnosis of Takayasu arteritis in children

作　　者：胡迪[1] 彭芸[1] 

机构地区：[1]首都医科大学附属北京儿童医院影像中心省部共建儿科重大疾病研究重点实验室,北京100054

出　　处：《放射学实践》2013年第7期719-723,共5页Radiologic Practice

基　　金：首都医学发展基金(2009-2077);北京市卫生系统高层次卫生技术人才培养项目(2011-3-054);科技重大专项项目(2011ZX09302-007-01)

摘　　要：目的:探讨多层螺旋CT血管成像(MSCTA)对儿童多发性大动脉炎的诊断价值。方法:回顾性分析本院37例多发性大动脉炎患儿的MSCTA资料,图像后处理方法包括多平面重组(MPR)、最大密度投影(MIP)和容积再现(VR)技术。结果:37例按Lupi-Herrea分类法,Ⅰ型2例,Ⅱ型18例,Ⅲ型15例,Ⅳ型2例。初诊时MSCTA检查显示所有受累血管共150支,狭窄-阻塞型37支,其中5支管腔闭塞,4支伴有细小侧支循环形成,1支伴局部血栓形成;扩张型11支,部分管壁伴有钙化;其余为混合型。狭窄血管中17支轻度狭窄、102支中度狭窄、15支重度狭窄、5支完全闭塞。不同时期受累血管均有不同程度的管壁增厚(2.0～7.0mm),活动期3.4～7.0mm,非活动期1.1～3.2mm。活动期CT平扫可见受累血管壁有环形低密度水肿状态带,增强扫描血管壁不均匀强化;非活动期局部血管可呈囊样扩张,管壁密度增高,部分可见钙化,增强扫描无强化。治疗后受累较轻血管可以完全恢复正常血管状态。结论:MSCTA在多发性大动脉炎的诊断方面有很高的准确性,可以作为多发性大动脉炎早期诊断的首选影像检查方法。Objective：To evaluate the clinical value of 64-slice CT angiography （MSCTA） in the diagnosis of Takaya su arteritis in children. Methods： The MSCTA materials of thirty-seven pediatric patients with Takayasu arteritis were retro-spectively analyzed. Post processing techniques including multi planar reformation （MPR）, maximum intensity projection （MIP） ,volume rendering （VR） were performed. Results： Of the 37 patients,according to Lupi-Herrea classification, there were type Ⅰ （2 cases） ,type Ⅱ （18 cases） ,type Ⅲ （15 cases） and type Ⅳ in （2 cases）. 150 abnormal vessels were observed during the first MSCTA examination,including 37 vessels of steno-occlusive type （5 occlusive type,4 with collateral circula-tion,1 with embolism）,11 vessels of eclasis type （some of them with calcifation） and 102 vessels of mix type. Among the vessels of steno occlusive type,17 was of slight level,102 was of moderate level,15 was of severe level,and 5 was of oeclu sive. The wall of vessels were all thickened in different period of the disease （2.0-7.0mm） ,3.4-7.0mm for the active phase, 1.1-3.2mm for the resting phase. During the active phase,CT of vessels wall showed circle edema with heterogenei-ty enhancement, and during the rest phase, they showed bubble dilated with high density, non enhancement and calcification. The vessels which with slight lesion were almost become normal after regular treatment. Conclusion： MSCTA is a highly ac-curate imaging technique in the diagnosis of Takayasu arteritis,it could be used as the first choice for early diagnosis of mul tiple Takayasu arteritis.

关 键 词：大动脉炎 体层摄影术 X线计算机 血管成像 超声 

分 类 号：R816.92[医药卫生—放射医学]