Stanford B型主动脉壁内血肿合并血肿内局限性血池样强化病灶的影像学特征与预后分析  

Imaging findings and prognosis of Stanford type B aortic hematoma with localized blood pool-like enhanced focus

作　　者：王肖 薛玉国[1] 蒲俊舟[1] 黄连军[1] WANG Xiao;XUE Yuguo;PU Junzhou;HUANG Lianjun(Department of Interventional Diagnosis and Treatment,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科,100029

出　　处：《心肺血管病杂志》2020年第9期1085-1089,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理中心“青苗”计划专项经费资助(QML20170607);北京市委组织部优秀人才项目(2017000021469G216)。

摘　　要：目的:分析Stanford B型主动脉壁内血肿合并出现不同形态的局限的血池样强化病灶的影像学表现,及相对应不同类型影像学表现的临床预后是否有所不同。方法:选择2016年1月至2017年6月,在首都医科大学附属北京安贞医院,行全主动脉CT血管成像(CTA)且表现为Stanford B型壁内血肿合并局限的血池样强化病灶的患者50例,存在病灶75个。同时根据病灶的影像学表现是否存在内膜破口或分支血管将病灶分为两组,破口组和分支组,又将分支组依据是否存在内膜开口与主动脉相通分为两组,分支1组和分支2组。所有患者均进行CTA随访。结果:破口组和分支组病灶存在明显影像学上的差异,分支亚组影像学特征特异性并不明显。分支组病灶随访预后明显优于破口组病灶,分支1组随访预后优于分支2组。13例患者在随访过程中出现了相关并发症(病灶明显增大7例,夹层4例,瘤样扩张1例,持续性疼痛1例)进行了外科手术或腔内修复术等方法治疗。随访时间为12个月或截止至进行了干预治疗,随访过程中无相关死亡事件。结论:Stanford B型主动脉壁内血肿,合并血肿内血池样强化病灶中破口组,和分支组病灶之间存在影像学特征上的差异,Stanford B型壁内血肿合并存在内膜破口的病灶时,继续进展的概率较大,应引起临床重视。Objective:To investigate the imaging differences and clinical outcomes of Stanford B type aortic hematoma combined with localized blood pool-like enhanced lesions.Methods:From January 2016 to June 2017 at the Beijing Anzhen Hospital of Capital Medical University,50 patients with a total of 75 lesions were admitted,who underwent total aortic CT angiography(CTA)and presented with Stanford B type aortic hematoma combined with localized blood pool-like enhanced lesions.At the same time,the lesions are divided into rupture group and branch group according to whether there is intimal rupture or branch blood vessel,and the branch group is further divided into branch 1 group and branch 2 group according to whether there is endometrial opening communicating with aorta.All patients were followed up by CTA.Results:There were obvious radiographic differences between the lesions in the rupture group and the branch group,and the specificity of the imaging characteristics of the branch subgroup was not obvious.The follow-up prognosis of the branch group was better than that of the rupture group,and the follow-up prognosis of the branch 1 group was better than that of the branch 2 group.13 patients had related complications during the follow-up process(7 cases with obvious enlargement of the lesion,4 cases with aortic dissection,1 case with tumor-like expansion,and 1 case with persistent pain).They were treated by surgical operation or endovascular repair.The follow-up time was 12 months or until the intervention was performed,and there were no related deaths during the follow-up.Conclusions:The clinical outcomes of Stanford B type aortic hematoma combined with localized blood pool-like enhanced lesions are different.Combining with endometrial rupture indicates the Stanford B-type aortic hematoma is more likely to deteriorate.Patients should be given more clinical attention.

关 键 词：Stanford B型主动脉壁内血肿 血池样强化病灶 内膜破口 分支血管 预后 

分 类 号：R54[医药卫生—心血管疾病]