主动脉壁内血肿的影像学诊断及鉴别诊断

目的：探讨主动脉壁内血肿的影像学诊断和鉴别诊断。方法：回顾性分析16例经临床及CT和MRI诊断的主动脉壁内血肿及5例可疑壁内血肿患者的病例资料。12例因胸痛或腹痛入院、经CT或MRI扫描时发现,4例为外伤或内科疾病行胸部或腹部检查时意外发现;另外搜集18例主动脉夹层及11例主动脉瘤患者的影像学资料。结果：16例主动脉壁内血肿,表现为主动脉壁环形增厚7例,新月形增厚5例,环形和新月形增厚同时存在或不规则增厚4例,腔内无内膜片及真假两腔形成,增厚的血管壁内无对比剂进入。5例可疑主动脉壁内血肿表现为管壁轻度环形增厚。18例主动脉夹层均可见真假两腔及内膜片,其中14例其真假腔在横轴面图像上表现为＂D＂字形或反＂D＂字形,真假两腔内均有对比剂进入;11例主动脉瘤表现为血管瘤样扩张或梭形扩张,无真假两腔和内膜片,其中8例可见附壁血栓。结论：CT平扫及增强扫描结合图像后处理技术及MRI多方位成像能够诊断较为典型的主动脉壁内血肿,并与主动脉其它常见疾病相鉴别。     

胸主动脉夹层动脉瘤X线、超声心动图诊断

目的:在于提高胸主动脉夹层动脉瘤的X线平片诊断.资料与方法:摄心脏常规片10例,其中4例胸透;超声心动图8例.作者分析了其影像表现,并在心脏后前位片上对胸主动脉各部宽度进行了测量.结果:各部测量其平均值均大于正常,升主动脉与弓降部瘤样扩张8例,降主动脉边缘呈波浪状1例.超声心动图探及主动脉内摆动性内膜与夹层6例,升主动脉内破口3例.结论;普通X线检查对诊断本病有重要意义,超声心动图可确诊.     

钝性创伤性主动脉损伤的电子束CT诊断

目的：探讨电子束CT（EBCT）对钝性创伤性主动脉损伤（BTAI）的诊断价值。方法：采用美国Imatron C-150型EBCT扫描机对13例胸、腹部钝性创伤患者行连续容积增强扫描。结果：13例BTAI，升主动脉破裂1例，假性动脉瘤7例，主动脉夹层4例，主动脉壁内血肿1例。EBCT不仅能清晰显示BTAI的各种征象，还能同时显示其他的外伤性征象：皮下气肿、肋骨骨折、气胸、胸腔积液等。结论：BTAI表现各具特征，EBCT可明确诊断，是极适用于胸、腹部急症的快速、无创的检查方法。     

外伤性急性主动脉损伤的多层螺旋CT诊断

目的 探讨外伤性急性主动脉损伤的多层螺旋CT表现.方法 回顾分析15例经多层螺旋CT诊断、并经手术证实的主动脉损伤的CT表现.15例中男12例,女3例,年龄24～70岁.结果 13例外伤性动脉损伤位于主动脉弓峡部,其中5例为主动脉内膜撕裂,多层螺旋CT增强表现为血管腔内游离的内膜片.8例为血管壁全层破裂伴纵隔内及主动脉周围积血,两侧胸腔积血,多层螺旋CT增强表现为管腔局部突出伴周围血肿形成.1例位于胸腹主动脉交界处,1例位于胸动脉降部,均为主动脉全层破裂伴假性动脉瘤形成.结论 多层螺旋CT能准确、快速、方便地诊断外伤性主动脉壁损伤伴动脉管壁破裂后假性动脉瘤形成.     

主动脉壁内血肿的MSCT诊断

目的 探讨多层螺旋CT(MSCT)诊断主动脉壁内血肿的价值.方法 收集主动脉壁内血肿12例,对其MSCT表现进行回顾性分析.结果 12例按Stanford分型,A型3例,B型9例.MSCT表现:主动脉壁呈新月形增厚12例,厚度为10～16 mm,增强后未见强化;内膜钙化斑块内移7例;穿透性溃疡征3例;内膜渗漏4例;合并胸腔积液5例,心包积液1例,左髂总动脉及髂外动脉夹层1例;3例治疗后随访可见主动脉壁内血肿厚度呈动态变化.结论 MSCT能清晰显示主动脉壁内血肿的部位、累及范围、厚度及有无并发症,对临床诊治有重要的指导意义.     

64层螺旋CT血管成像在主动脉夹层术前的评价与应用

目的 评价64层螺旋CT血管造影(64-slice spiral CT angiography,64-SCTA)在主动脉夹层术前的应用价值.方法 回顾性分析63例主动脉夹层的64-SCTA征象,并与数字减影血管造影(digital subtraction angiography, DSA)结果进行了比较.结果 De BakeyⅠ型8例,De BakeyⅡ型2例,De BakeyⅢ型45例,主动脉壁内血肿8例.主动脉腔内见线状低密度内膜瓣影55例,将主动脉分成真假两腔, 64-SCTA显示破入口位于升主动脉10例,距动脉瓣平均(5.65±2.93)cm,位于弓降部左锁骨下动脉开口以远44例,瘤颈长度平均(2.69±2.03)cm;瘤颈直径平均(2.86±6.06)cm.64-SCTA精确显示夹层破入口25例,DSA精确显示19例,两者有明显差异(P＜0.05).结论 64-SCTA在主动脉夹层术前有很高的应用价值,不但能明确诊断,还可为治疗方法的选择提供可靠依据,应作为首选检查方法.     

MSCT在主动脉壁内血肿诊断和转归中的应用

目的 探讨MSCT在主动脉壁内血肿(IMH)诊断和转归中的应用价值.方法 采用GE 16排螺旋CT对11例IMH行平扫和CTA扫描.3例行腔内支架隔绝术,8例保守治疗.所有病例治疗后随访2～4次,随访时间15～210 d(平均112.5 d).结果 A型IMH 3例,B 型IMH 8例.MSCT主要征象为:11例主动脉壁新月形或环形增厚＞5 mm,呈等密度或高密度,无内膜片撕裂及真、假两腔形成;主动脉粥样硬化7例;内膜钙化内移4例;内膜渗漏3例;穿透性溃疡3例.7例完全吸收,2例部分吸收,2例进展成夹层动脉瘤.结论 MSCT能对IMH作出明确的诊断,并可作为IMH随访的重要检查手段,对临床治疗有重要的指导意义.     

不典型主动脉夹层的CT表现

目的探讨不典型主动脉夹层(AAD)的CT表现。资料与方法采用双螺旋CT进行增强前后扫描．共发现AAD24例．其中11例手术治疗。结果AADCT表现为：(1)均未见典型主动脉夹层(TAD)的CT表现(无撕裂内膜片和双腔显示)；(2)主动脉壁新月形或环状增厚(假腔)达5～30mm；(3)平扫假腔密度高于、等于或低于主动脉真腔者分别为12例、8例和4例；(4)增强扫描假腔均无强化；(5)92％(22例)病变主动脉无明显受压改变；(6)随诊假腔有变化。AAD与TAD相同点：(1)发生部位同TAD发生部位一致；(2)4例见钙化内膜内移征象；(3)63％并发胸腔积液；(4)A型67％并发心包积液；(5)破口不易显示，与手术对照，破口显示率为36％。CT所示假腔内高密度者6例，手术为新鲜或较新鲜血块，混合存在于中膜和内膜之间，假腔内等低密度者为较陈旧血块5例。6例复查AAD吸收。结论AADCT主要特点是：无撕裂内膜片和双腔显示，主动脉壁新月形或环状增厚，平扫密度高于、等于或低于主动脉真腔，增强扫描均无明显强化和保守治疗有效。     

主动脉夹层的CT征象分析

<正> 主动脉夹层(aortic dissection,AD)过去曾称为主动脉夹层动脉瘤(disseation aortic aneurysm),系指各种原因造成动脉壁内破裂,血液通过内膜的破口进入动脉壁中层而成血肿,导致血管壁分离,剥离的内膜片分离形成"双腔主动脉"。笔者回顾性分析23例患者的完整资料,以总结对主动脉夹层有诊断价值的CT平扫和增强扫描征象,现报告如下。     

主动脉夹层渗漏入心包1例报告

主动脉夹层渗漏入心包少见 ,现将我院经彩超证实的 1例报告如下。女 ,6 8岁 ,突发晕厥半小时伴大汗。查体 :Ｐ 10 8次 /ｍｉｎ ,血压测不到。听诊 :心音低弱。ＣＴ检查 :升、降主动脉增宽 ,直径分别达到 5 .6ｃｍ、5ｃｍ ,升主动脉见真假腔 ,其假腔内见新月状高密度影 ,心包内见环形带状高密度影 (附图 )。意见 :主动脉夹层渗漏或破入心包。讨论 :主动脉夹层是指由于动脉中层弹性纤维减少、变性、断裂、坏死或中层平滑肌退行性变导致内膜破裂 ,动脉内血液通过破口进入血管壁中层而形成的血肿。主要病因有 :( 1)动脉粥样硬化 ;( 2 )感染 ;( 3…     

Spontaneous progression of ascending aortic intramural hematoma to Stanford type A dissection fortuitously witnessed during an MR examination

Aortic intramural hematoma may occur as a primary event (spontaneous dissection without intimal flap) or secondary to a penetrating atherosclerotic ulcer. The management of intramural hematoma of the ascending aorta is somewhat controversial because of limited published data, but some centers advocate early surgical intervention. We describe a patient with an intramural hematoma of the ascending aorta that progressed to a classic communicating dissection during an MR examination. This case graphically demonstrates the potential instability of patients with intramural hematoma of the ascending aorta.     

JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.     

CT demonstration of dissecting hematoma originating in abdominal aorta

This report presents two cases of abdominal aortic dissecting hematoma without involvement of the thoracic aorta. Computed tomography can reliably diagnose or exclude aortic dissection by demonstrating the specific findings of an intimal flap and displacement of intimal calcification into the aortic lumen.     

Aortic dissection: atypical patterns seen at MR imaging

Aortic dissection is typically manifested by an intimal flap separating true and false lumens. Atypical patterns lacking an intimal flap can occur, however, and are less well recognized. In this study, the authors review their experience with atypical patterns at magnetic resonance (MR) imaging. They evaluated the T1-weighted and gradient-echo MR images of the entire aorta in 64 patients with aortic dissection. In nine patients (14%) aortic wall thickening was the only sign of dissection in the thorax. In three of these cases, an intimal flap was found in the abdominal aorta; the other six patients had no flap in any region of the aorta, and this led to false-negative angiographic results in three cases. Aortic wall thickening as an atypical sign of dissection was seen more frequently in acute (29%) than in chronic (7%) dissection and was seen in only patients without Marfan syndrome. Two patients with atypical acute dissection at initial examination developed a clearly identifiable intimal flap at follow-up. Aortic wall thickening may represent the only sign of aortic dissection. In some cases, imaging the entire aorta can enable recognition of dissection in atypical cases.     

Clinical application of single shot GRE-EPI as non-enhanced MRA (EPI-MRA) for aortic aneurysm and dissection

We investigated the usefulness of single shot gradient echo type echo planar imaging (GRE-EPI) as magnetic resonance angiography (MRA) for the diagnosis of aortic aneurysm and dissection. This technique can detect blood flow signals in several tenths of a milliseconds without the need for contrast medium, breath-holding, or electrocardiographic (ECG) gating. By scanning approximately 20 frames in the coronal plane, three-dimensional (3D) imaging can be achieved by maximum intensity projection (MIP) at different angles. Three radiologists evaluated the ability of this single shot GRE-EPI as non-enhanced MRA (EPI-MRA) to diagnose aortic aneurysm and dissection. The examined lesions consisted of three cases of thoracic aortic aneurysm, seven of abdominal aortic aneurysm and eight of aortic dissection with a total of 15 involved aorta. In all patients with aortic aneurysm, EPI enabled detection and diagnosis of the aneurysm. However, the size of the lesion and relationship with major branches were determined only in the abdominal aorta, and could not be determined precisely in thoracic lesions. Similar results were obtained for patients with aortic dissection. The technique visualized the intimal flap and enabled determination of the extent of dissection in the abdominal aorta. In the thoracic aorta, serious magnetic susceptibility artifacts caused image distortion, and as a result only the dissection could be detected and diagnosed. No entry site was detected at either the abdominal or thoracic aorta. These results suggest that EPI-MRA may have a clinical potential for screening patients with acute aortic disease who cannot undergo physical restraint for scanning.     

MRI和螺旋CT对主动脉夹层的对比研究及其临床应用

目的对比分析磁共振成像(MR I)和螺旋CT诊断主动脉夹层(AD)的影像特征,评价2种技术对临床的应用价值。方法回顾性分析经手术或临床证实的18例AD的MR I和螺旋CT表现。结果2种先进检查技术诊断AD的敏感性和特异性均较高,能不同程度地显示AD的范围及其分型、真假腔、内膜片和内膜破口、附壁血栓和壁内血肿、主动脉的扩张和狭窄及其分支血管受累情况。结论对疑有AD者应行MR I或螺旋CT检查,MR I与CT对病变范围及分型、真假腔及主动脉的狭窄和扩张的显示相似;而内膜片、内膜破口、附壁血栓和壁内血肿、主动脉整体及分支受累的显示MR I明显优于螺旋CT;对内膜及主动脉壁钙化、急危重者的检查螺旋CT优于MR I。     

胸主动脉MR仿真内镜检查的临床应用及其缺陷

目的：研究MR仿真内镜（MRVE）对胸主动脉解剖及病变的临床应用价值。探讨其成像方法及存在缺陷。方法：对20例健康检查者及33例临床考虑胸主动脉病变的患者行MR三维动态增强扫描血管成像（3D-DCE-MRA）检查，将其原始数据进行仿真内镜重建处理，观察其对血管内表面解剖及病变的显示能力。结果：MRVE直观地显示胸主动脉解剖及病变情况，21例夹层动脉瘤，MRVE清楚地显示夹层动脉瘤入口，内膜移位及瘤腔情况；对主动脉瘤及大动脉炎可显示其扩张或缩窗的内腔结构；对法乐氏四联征，清楚地显示主动脉骑跨及骑跨程度；半环状伪影为MRVE主要存在的伪影。结论：MRVE能直观地显示胸主动脉内壁的解剖及病变情况，可作为临床怀疑胸主动脉病变患者的常规检查手段。     

The thoracic aorta studied by MR imaging

Thirty-three patients with a variety of disorders of the thoracic aorta (aneurysm, dissection, Marfan syndrome, coarctation/pseudocoarctation, L-transposition, and Takayasu disease) were evaluated with magnetic resonance (MR) imaging. MR imaging delineated the presence and extent of thoracic aortic aneurysms and showed the relationship of the aneurysm to arch vessels; it also demonstrated intimal flaps and individual lumina in types A and B aortic dissection. Dilation of the ascending aorta in Marfan syndrome and focal narrowing of the aorta in coarctation were well visualized. The anteroposterior and side-to-side relationships of the aorta and pulmonary artery in L-transposition were demonstrated, as were aortic wall thickening and branch vessel narrowing in Takayasu arteritis. Initial experience suggests that MR imaging may provide a noninvasive method for evaluating thoracic aortic disease. Limitations include inferior spatial resolution, occasional difficulty in imaging the entire region of interest in one section, lack of signal from calcifications, and inability to monitor critically ill patients.     

Thoracic aortic disease: Spectrum of multidetector computed tomography imaging findings

The clinical presentation of diseases involving the thoracic aorta ranges from a large number of asymptomatic patients with clinically undetectable thoracic aortic aneurysm to patients with symptoms of severe chest pain as a result of acute aortic dissection. Thoracic aortic disease often remains undiagnosed until a life-threatening complication occurs or the disease is discovered serendipitously on imaging studies performed for other purposes. Multidetector row computed tomography (MDCT) imaging of the aorta is used to diagnose various acute and chronic conditions, including aortic aneurysms, aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, traumatic injury, rupture, inflammatory disorders, and congenital malformations. This review illustrates the wide range of MDCT imaging findings of thoracic aortic disease.