急性Stanford A型主动脉夹层伴肺动脉鞘血肿的CT血管成像表现及其临床意义  

Clinical implications of CT angiography finelings of Stanford A acute aortic dissection associated with hemorrhagic pulmonary sheath

作　　者：陈则君 费锋 高福磊 谢旭纲 Chen Zejun;Fei Feng;Gao Fulei;Xie Xugang(Department of Radiology,Affiliated Jiangyin Hospital of Nantong University,Jiangyin 214400,China;Department of Intervetional Radiology,Affiliated Jiangyin Hospital of Nantong University,Jiangyin 214400,China)

机构地区：[1]南通大学附属江阴医院影像科,江阴214400 [2]南通大学附属江阴医院介入科,江阴214400

出　　处：《中华解剖与临床杂志》2024年第5期331-336,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨急性Stanford A型主动脉夹层(ATAAD)伴肺动脉鞘血肿(HPS)CT血管成像(CTA)的影像学特点及临床价值。方法回顾性队列研究。纳入2018年1月—2023年11月南通大学附属江阴医院经CTA诊断的83例ATAAD患者的临床及影像学资料,其中男66例、女17例,年龄28~88(56.8±15.2)岁。根据HPS诊断标准将患者分为HPS组(12例)和无HPS组(71例)。观察指标:(1)分析HPS组患者的CT平扫肺动脉周围高密度影及其CTA表现,受累主肺动脉、肺动脉主干狭窄程度,以及HPS的分型。(2)比较2组患者的基线资料(年龄、性别),升主动脉真、假腔直径,主要分支动脉(弓上动脉、腹腔动脉、肾动脉、髂股动脉)的受累情况,以及合并心包积液、胸腔积液占比等的组间差异。结果(1)12例HPS患者中,有10例(10/12)CT平扫显示肺动脉周围高密度、CTA显示为主动脉根部侧壁和肺动脉间片条状低密度影并沿肺动脉延伸;9例HPS累及右侧肺动脉,7例肺动脉狭窄≥50%,5例肺动脉狭窄<50%;HPS分型:Ⅰ型6例,Ⅱ型6例。(2)2组患者年龄、性别、升主动脉真腔直径,以及弓上动脉、腹腔动脉、肾动脉、髂股动脉受累及合并胸腔积液等比较,差异均无统计学意义(P值均>0.05)。HPS组的升主动脉假腔直径[(34.7±11.9)mm]大于无HPS组[(27.5±11.0)mm],HPS组合并心包积液占比(10/12)高于无HPS组(36.6%,26/71),差异均有统计学意义(P值均<0.05)。结论ATAAD伴HPS患者的CTA多表现为主动脉根部侧壁和肺动脉间片条状低密度影;HPS多累及右肺动脉,同时合并肺动脉狭窄和升主动脉假腔直径增大。CTA能清晰显示HPS及重要分支血管受累情况,同时明确受累肺动脉狭窄程度及HPS分型,具有快速诊断HPS的价值。Objective This study aimed to investigate the CT angiography(CTA)features and clinical applications of acute type A aortic dissection(ATAAD)associated with hemorrhagic pulmonary sheath(HPS).Methods A retrospective cohort study was conducted on the clinical and imaging data of 83 patients with ATAAD diagnosed by CTA in Jiangyin Hospital Affiliated to Nantong University from January 2018 to November 2023.The patients including 66 males and 17 females aged 28−88(56.8±15.2)years were divided into HBS groups(n=12)and non-HBS groups(n=71)according to the HPS criteria.(1)The high density shadow around the pulmonary artery on the plain CT and CTA findings of patients in the HPS group were analyzed.The main pulmonary artery involved,degree of stenosis of the main pulmonary artery,and classification of HPS were also examined.(2)Clinical indicators(age,gender),diameter of true and false lumen of the ascending aorta,involvement of main branch arteries(superior arch artery,celiac artery,renal artery,iliofemoral artery),and combined pericardial effusion and pleural effusion were compared between the two groups.Results(1)Among these 12 patients with HPS,10 patients showed high density around pulmonary artery on plain CT,10 patients showed low density patchy between the lateral wall of the aortic root and the pulmonary artery and extending along the pulmonary artery on CTA,9 patients had HPS involving the right pulmonary artery,7 patients had pulmonary artery stenosis≥50%,and 5 patients had pulmonary artery stenosis<50%.According to the HPS classification:6 patients had typeⅠ,and 6 patients had typeⅡ.(2)No significant differences in baseline data(age,gender),ascending aorta true lumen diameter,superior arch artery,celiac artery,renal artery,iliofemoral artery involvement,and pleural effusion were found between the two groups(all P values>0.05).The diameter of ascending aortic false lumen in the HPS group was(34.7±11.9)mm,which was larger than that in the non-HPS group(27.5±11.0)mm.The pericardial effusion(10/12)in the

关 键 词：主动脉疾病 Stanford A型主动脉夹层 肺动脉鞘血肿 CT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]