256层螺旋CT血管成像诊断主动脉夹层的临床价值  

The diagnostic value of 256-slice spiral CT angiography in aortic dissection

作　　者：彭峰河[1] 彭如臣[1] 石逸杰[1] 蔡建新[1] 王海丽[1] 赵亮[2] 李坤成[3] 

机构地区：[1]首都医科大学附属北京潞河医院放射科,北京101149 [2]首都医科大学附属北京潞河医院血管外科,北京101149 [3]首都医科大学宣武医院放射科,北京100053

出　　处：《临床和实验医学杂志》2016年第7期695-699,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的评价256层螺旋CT血管成像(CTA)对主动脉夹层的诊断价值。方法收集56例连续典型主动脉夹层患者资料,均行256层螺旋CT血管成像扫描,并将原始数据进行多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)等重建后处理,回顾性分析其影像学特点。结果 56例主动脉夹层患者依据De Bakey分型:Ⅰ型14例,Ⅱ型2例,Ⅲ型40例。所有患者真假双腔及内膜片均清晰显示,其中3例(5.4%)患者为三腔(双假腔)主动脉夹层,其一例患者急性期假腔及伴有血栓的慢性期假腔各一个。真腔Ct值多较假腔高,差异有统计学意义(P<0.05)。CTA显示了所有患者初始破口的位置,并发现50例(89.2%)患者存在一个破口或多个再破口,6例(10.7%)未见再破口。CTA清晰显示了主动脉夹层范围、重要分支血管受累、内膜片旋转方向以及假腔内血栓形成情况。结论 256层螺旋CT血管造影具有无创、快速、准确性高等优点,是诊断主动脉夹层的可靠影像检查方法之一。Objective To investigate the clinical value of 256- slice spiral CT angiography（ CTA） in the diagnosis of aortic dissection（ AD）. Methods A total of 56 consecutive patients with typical aortic dissection underwent 256- slice spiral CT angiography. The original raw data were post- processed with multiplanar reformation（ MPR）,maximum intensity projection（ MIP） and volume rendering（ VR） and the results were retrospectively analyzed. Results Based on De Bakey classification,there were 14 cases of Type Ⅰ aortic dissection,2 cases of Type Ⅱ,40 cases of Type Ⅲ classified by the CTA results of these 56 patients. True and false lumen and intimal flap tearing could be clearly shown in all of those 56 patients,including of three patients with triple- barreled（ double false lumens） aortic dissection（ one false lumen was acute,the other was chronic with murl thrombus in one of three patients） located in descending thoracic aorta. Furthermore,the mean CT value after enhancement in the true lumen was higher than that in false lumen in arterial phase（ P〈0. 05）. Initial entry sites were well defined in all patients,and one or multiple reentry sites were revealed in 50 patients（ 89. 2%）,but not in 6 patients（ 10. 7%）. CTA clearly displayed the aortic and its main branches involved by dissection,rotation direction of intimal flap,thrombus formation within false lumen. Conclusion The advantages of 256- slice spiral CT angiography are fast,noninvasive and highly effective which is one of the reliable imaging methods in the diagnosis of aortic dissection.

关 键 词：主动脉夹层 体层摄影术 X线计算机血管成像 

分 类 号：R543.1[医药卫生—心血管疾病] R816.2[医药卫生—内科学]