急性主动脉壁间血肿的多层螺旋CT血管造影影像学表现和诊断价值  

Imaging findings and clinical value of multiple-slice computed tomography angiography in acute aortic intramural hematoma

作　　者：陈相猛[1] 段晓蓓[2] 金志发[1] 张朝桐[1] 李卓永[1] 龙晚生[1] 

机构地区：[1]中山大学附属江门医院放射科,529070 [2]中山大学附属江门医院核医学科,529070

出　　处：《国际放射医学核医学杂志》2017年第4期258-264,共7页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的 探讨急性主动脉壁间血肿（AAIH）的多层螺旋CT血管造影（MSCTA）影像学特征和临床应用价值。方法 回顾性分析临床确诊76例AAIH患者的主动脉MSCTA检查资料，依据Stanford分型分为A型和B型，比较不同Stanford分型AAIH的影像学表现有无差异。根据患者随访期间的不同变化分为进展组与稳定和缓解组，分析进展的相关因素。所有结果均行统计学分析，符合正态分布的定量资料采用两独立样本t检验；不符合正态分布的定量资料采用Mann-Whitney U检验。定性资料采用χ^2检验。结果 Stanford A型27例（35.5%）、B型49例（64.5%）。A型、B型壁间血肿最大厚度、溃疡类病变、局灶性强化、胸腔积液上的差异均无统计学意义（Z=-0.788、χ^2=0.441、χ^2=0.383、χ^2=0.338，均P〉0.05）。A型、B型溃疡类病变的深度分别为（2.8±2.9）mm、（2.5±3.3）mm，差异有统计学意义（Z=-2.345，P=0.019）。心包积液15例（19.7%），A型12例多于B型3例，差异有统计学意义（χ^2=16.138，P〈0.001）。41例AAIH患者短期随访，进展组20例，稳定和缓解组21例。单因素分析显示，进展组与稳定和缓解组在溃疡类病变、溃疡深度、胸腔积液间的差异均具有统计学意义（χ^2=9.227、Z=-2.689、χ^2=4.111，均P〈0.05）；在Stanford分型、壁间血肿厚度、局灶性强化、心包积液上的差异均无统计学意义（ χ^2=1.453、Z=-0.874、χ^2=0.006、χ^2=1.733，均P〉0.05）。将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析，显示溃疡类病变是影响AAIH的独立危险预测因子。结论 AAIH在MSCTA上表现为平扫密度较高、增强无强化的环形或新月形增厚主动脉管壁。MSCTA检查可以对AAIH做出快速、准确诊断。溃疡性病变是影响AAIH进展的独立危险因素。AAIH早期需要密切随访，监测有无进展。Objective To explore the imaging findings in and clinical value of multiple-slice computed tomography angiography （MSCTA） in acute aortic intramural hematoma （AAIH）.Methods A total of 76 AAIH cases with complete clinical information were recruited and subjected to MSCTA examinations.The patients were divided into progressive and stable groups according to the follow-up changes.Then,the clinical data and MSCTA features were compared.All outcomes were analyzed statistically.The quantitative data of normal distribution and abnormal distribution were tested by two independent samples and Mann-Whitney U test,respectively.The qualitative data were tested by chi-square test.Results A total of 27（35.5%） type A cases and 49（64.5%） type B cases were classified according to Stanford criteria.No significant difference in the maximum thickness of aortic hematoma,number of ulcer-like projections,degree of focal enhancement,and severity of pleural effusion was noted between the Stanford A and B groups （Z=-0.788,χ^2=0.441,χ^2=0.383,χ^2=0.338,all P〉0.05）.The ulcer depths in the Stanford A and B groups were （2.8±2.9） and （2.5±3.3） mm,respectively （Z=-2.345,P=0.019）.Meanwhile,15（19.7%） cases （12 type A cases and 3 type B cases） were accompanied by pericardial effusion （χ^2=16.138,P〈0.001）.Twenty cases belonged to the progressive group,whereas 21 cases were included in the stable group.Univariate statistical analysis showed significant differences in ulcer-like projection,ulcer depth,and pleural effusion between the progressive and stable groups （χ^2=9.227,Z=-2.689,χ^2=4.111,all P〈0.05）.By contrast,no significant difference in Stanford subtype,maximum aortic thickness,maximum aortic hematoma thickness,focal enhancement,and pleural effusion was noted between the Stanford A and B groups （χ^2=1.453,Z=-0.874,χ^2=0.006,χ^2=1.733,all P〉0.05）.Multivariate analysis revealed that the amount of ulcer-like projections was the independent risk factor for AAIH progression.Con

关 键 词：主动脉 体层摄影术 X线计算机 血管造影术 壁间血肿 

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