摘要
目的 探讨256层螺旋CT血管成像(MSCTA)对急性主动脉综合征(AAS)的诊断价值。方法 收集91例急性主动脉综合征患者的临床及影像资料,对MSCTA图像表现进行分析。结果 91例AAS患者中68例主动脉夹层,其中StanfordA型28例,B型40例,CTA不仅能清晰显示真假腔结构、内膜破口和移位的内膜片,也可以对假腔内血栓、上纵隔或心包积血进行评价,与DSA诊断结果一致。主动脉壁间血肿12例,StanfordA型2例,B型10例,5例可见钙化内膜移位,2例内壁可见溃疡形成,3例表现为内膜渗漏。主动脉粥样硬化性穿透性溃疡8例,共有23处病灶,位于主动脉弓6处,降主动脉15处,髂总动脉2处。不稳定的胸主动脉瘤3例,2例患者瘤体内可见壁内血肿和附壁血栓形成,1例瘤体外见到少量对比剂渗出。结论 MSCTA能对AAS进行准确的诊断和鉴别诊断,为临床治疗和术后评估提供关键的依据。
Objective To evaluate the diagnostic value of 256-slice spiral CT angiography (MSCTA) in acute aortic syndrome (AAS). Methods The clinical and imaging data of 91 patients with acute aortic syndrome from 2015 to 2018 were collected and the MSCTA findings were analyzed retrospectively. Results There were 68 cases of aortic dissection in 91 cases of AAS, including 28 cases of Stanford type A and 40 cases of type B dissection. CTA could not only clearly display true and false lumen sign, intimal rupture and avulsed intimal flap, but also evaluate false lumen thrombus, upper mediastinum or pericardial hemorrhage. It was consistent with DSA diagnosis. There were 12 cases of intramural hematoma, 2 cases of Stanford type A, 10 cases of type B, 5 cases can be seen calcified endometrial displacement, 2 cases of ulcer formation in the inner wall and 3 cases of intimal leakage. There were 23 lesions in 8 cases of atherosclerotic penetrating ulcer of aorta, 6 lesions located at aortic arch, 15 at descending aorta and 2 at arteria iliaca communis. There were 3 cases of unstable thoracic aortic aneurysm, intramural hematoma and mural thrombosis were found in 2 cases, and a little contrast agent exudation was observed in 1 case. Conclusion MSCTA can make accurate diagnosis and differential diagnosis of AAS, and provide a key basis for clinical treatment and postoperative evaluation. It has important clinical application value.
作者
秦斌
刘绍伟
武惠明
王中秋
QIN Bin;LIU Shaowei;WU Huiming;WANG Zhongqiu(Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, P.R.China)
出处
《医学影像学杂志》
2019年第8期1301-1305,共5页
Journal of Medical Imaging
关键词
急性主动脉综合征
主动脉夹层
壁间血肿
动脉粥样硬化性溃疡
胸主动脉瘤
体层摄影术
X线计算机
Acute aortic syndrome
Aortic dissection
Intramural hematoma
Penetrating atherosclerotic ulcer
Unstable thoracic aortic aneurysm
Tomography, X-ray computed tomography
