血管覆膜支架置入治疗胸主动脉夹层动脉瘤

目的:介绍覆膜支架血管内置入治疗胸主动脉夹层动脉瘤(TADA)的初步经验。方法:本组4例Debakey B型胸主动脉夹层动脉瘤,经CT或MR增强检查确诊。经股动脉置入覆膜支架,封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访采用彩超或增强CT检查。结果:4例患者共成功置入7个支架,1例术后支架远端出现内漏,6个月后内漏自行封闭;1例并发的腹主动脉瘤随访2个月无变化;随访2~18个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。结论:覆膜支架血管内置入治疗胸主动脉夹层动脉瘤的近期疗效满意。     

主动脉夹层动脉瘤21例临床分析

目的:进一步提高主动脉夹层动脉瘤的诊治水平,降低死亡率。方法:2000——2006年间诊治的主动脉夹层动脉瘤进行回顾性分析。结果:首诊确诊率57.1%,死亡率30%。21例病例存在早期确诊困难,误诊率高。结论:通过提高认识,采用彩色多普勒超声、MRI、CT对疑似病例进行早期诊断;系统内科治疗及人工血管植入是提高夹层动脉瘤病人生存的关键。     

16层螺旋CT血管成像检测主动脉夹层动脉瘤的护理配合

目的：探讨16层螺旋CT血管成像（MSCTA）在主动脉夹层动脉瘤检查中的护理配合方法。方法：回顾性分析进行MSCTA检查的20例患者,经工作站进行图像后处理,观察主动脉成像的CT图像质量,总结检查过程中的护理操作和体会。结果：20例主动脉夹层动脉瘤患者均获得了满意的检查效果,重建图像均能显示所要观察的动脉血管的主干及其主要分支,全部达到诊断目的,其中1例返回病房后6h因主动脉夹层破裂,抢救无效死亡。结论：16层螺旋CT血管成像在检测主动脉夹层动脉瘤中具有独特的优越性,精心的护理配合是取得检查成功的重要保证。     

主动脉假性动脉瘤的影像诊断

目的：探讨主动脉假性动脉瘤的影像表现，评价MRI的诊断价值。方法：报道5例经手术证实的主动脉假性动脉瘤的影像所见，MRI检查4例，彩超检查3例，CT检查2例和主动脉造影1例。结果：胸、腹主动脉假性动脉瘤分别为3例和2例，假性动脉瘤位于主动脉轮廓外。彩超显示瘤体与主动脉有双向血流。CT和主动脉造影表现层状密度瘤体、早期强化和显影。MRI表现假性动脉瘤壁厚薄不均和信号不均质，均有破裂口。GRE显示经主动脉狭窄破裂口向瘤腔内喷射高信号血流。结论：MRI对假性动脉瘤的诊断有重要价值。     

螺旋CT血管造影术在夹层动脉瘤诊断中的应用

目的评价螺旋CT血管造影技术在夹层动脉瘤诊断中的临床应用价值。方法21例夹层动脉瘤行螺旋CT连续容积增强扫描，并将获得的数据传至工作站行三维重建，结合横断面及三维重建图像进行分析。结果根据Debakey分型，De．bakeyⅠ型10例，DebakeyⅢ型11例，两型中不典型夹层各2例。典型夹层动脉瘤的CT征象主要是分离移位的内膜、真假腔、主动脉壁增厚、钙化、主动脉不规则扩张；不典型主动脉夹层动脉瘤的征象为主动脉壁呈半月状或环状增厚，伴或不伴有内膜钙化内移。结论螺旋CT血管造影检查在诊断主动脉夹层动脉瘤中是一种安全有效的便于治疗后观察对比的方法。     

螺旋CT三维动态增强血管成像对急性期主动脉夹层动脉瘤的诊断价值

主动脉夹层动脉瘤起病急骤，进展迅速，发病0～48h内病死率由360％升至75％。在急性期内对主动脉夹层动脉瘤进行准确定位，及时治疗，可以显著提高患者生存率。搜集我院自2005年3月至12月行急诊螺旋CT三维动态增强血管成像（3D DCE SCTA）检查39例主动脉夹层动脉瘤患者资料，探讨3D DCE SCTA对急性期主动脉夹层动脉瘤的诊断价值。     

多层螺旋CT诊断急性腹部假性动脉瘤临床价值分析

目的 探讨急性腹部假性动脉瘤（visceral artery pseudoaneurysm,VAPA）的多层螺旋CT影像学表现及其诊断价值。方法 本文对我院20例急性腹部假性动脉瘤患者多层螺旋CT的临床资料进行分析。结果 本文20例急性腹部假性动脉瘤患者在平扫时VAPA中心密度均匀或不均匀,13例呈现稍低密度,3例呈现稍高密度,4例表现为混杂密度。CT均发现为圆形或类圆形边缘光滑的软组织肿块,与腹主动脉或母体血管关系密切。20例在经肘正中静脉注射碘海醇后的增强扫描后部分或全部明显强化;增强扫描后12例瘤体中央处增强与腹主动脉同步,8例瘤体增强稍迟于动脉,随时间的延长,瘤体密度逐渐升高,等于并超过腹主动脉密度。结论 CT检查腹部假性动脉瘤的简便、无创和可靠检查方法,尤其是行增强MSCT和CTA对腹部假性动脉瘤的诊断具有重要意义。     

Behcet综合征累及心血管系统的CT诊断

目的 探讨累及心血管系统的Behcet综合征影像特点及其诊断.方法 搜集1995年7月至2007年12月临床诊断为Behcet综合征累及心血管系统患者11例的电子束CT(EBCT)或64层MSCT检查资料,回顾分析其cT影像特点.结果 11例Behcet综合征患者的CT影像表现为:累及主动脉瓣4例(其中2例同时累及二尖瓣),右冠状动脉假性动脉瘤2例(其中1例同时形成右腋动脉假性动脉瘤,3.5年后无诱因出现腹主动脉假性动脉瘤),左锁骨下动脉假性动脉瘤1例(伴腹主动脉下段闭塞),主动脉弓部真性动脉瘤及溃疡1例,主动脉弓部假性动脉瘤1例,主动脉夹层1例,肺动脉栓塞伴房间隔瘤1例.结论 CT作为Behcet综合征诊断及定期随访的检查手段,可明确心血管系统受累情况,根据其病变的影像特点,为选择临床治疗方法提供依据.     

平板旋转血管造影及三维重组在主动脉病变中的应用

目的:评价平板旋转血管造影及三维重组在主动脉病变临床应用的价值.方法:对比分析31例主动脉病变患者的CT或MR、二维血管造影、旋转血管造影及三维重组影像学资料,并对其结果对比分析.31例均为男性,年龄18～81岁,平均56.5岁.结果:行胸主动脉造影28例,发现主动脉夹层25例,动脉瘤1例,假性动脉瘤1例,主动脉弓畸形1例.行腹主动脉造影3例,发现动脉瘤2例,1例为腹主动脉动脉硬化性改变并主动脉钙化.所有主动脉夹层、真性及假性动脉瘤造影与CT或MRI对比,病变的形态、大小、位置均相符.其中有2例夹层的造影提示CT诊断破口位置错误.1例主动脉弓畸形,CT误诊为动脉瘤,而造影则可以清晰显示扩张纡曲的畸形主动脉弓.其中23例主动脉夹层和3例真性动脉瘤造影后进行支架主动脉腔内隔绝术的介入治疗,术后均行二维血管造影,支架位置准确,隔绝效果良好,没有出现并发症.结论:平板旋转血管造影及三维重组对主动脉病变的诊断和治疗有较高的临床应用价值,可以提高介入治疗的安全性和成功率.     

主动脉夹层的CT及MRI诊断

目的探讨主动脉夹层的CT及MRI表现,评价CT及MRI的诊断价值。方法18例经手术或临床证实的主动脉夹层患者均经CT及MRI检查,CT检查15例,MRI检查14例。结果本组18例中,I型8例,Ⅲ型10例。主动脉夹层位于主动脉轮廓外,CT平扫和增强扫描显示层状密度瘤体,早期强化和显影,MRI显示主动脉夹层壁厚薄不均和信号不均质,均有破裂口。结论CT及MRI对主动脉夹层的诊断有重要价值且操作简单、安全、诊断明确,能帮助和指导手术。     

Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient

A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.     

Spared flow tract within the mural thrombus of an aortic aneurysm: its pathogenesis and clinical importance

The purpose of this case report is to determine the unique pathogenesis of a "spared flow tract" through a thick mural thrombus of an aortic aneurysm mimicking the penetrating or dissecting tract of an impending or acute rupture of an abdominal aortic aneurysm (AAA) and to discuss its clinical importance. Three blood flow tracts (i.e., spared flow tracts) penetrating to aortic major branches (inferior mesenteric arteries in two and left renal artery in one) through thick mural thrombi of three aortic aneurysms were found on thin section spiral CT scans. Histopathological examination revealed that the tracts were formed by thrombi and partially covered with endothelial cells. In conclusion, spared flow tracts may be pathways continuing to the aortic major branches through thick mural thrombi of aortic aneurysms and are spared from thrombogenesis because of relatively high blood flows. Their pathogenesis is definitely different from penetrating or dissecting tracts within mural thrombi of ruptured AAAs. Spared flow tracts should not be misinterpreted as penetrating or dissecting tracts of impending or acute rupture.     

彩色多普勒超声对腹主动脉瘤诊断与分型价值的探讨

目的：探讨彩色多普勒超声在诊断腹主动脉瘤中的应用价值。方法：回顾性分析近6年来彩色多普勒超声首先检出的腹主动脉瘤21例，并与CT强化扫描检查对照。全部病例均经X线血管造影证实。结果：超声与CT对腹主动脉瘤的敏感性、特异性强，诊断结果可靠，但对夹层动脉瘤破裂口、真假腔问剥脱的内膜及假腔内血栓的显示等方面彩色多普勒超声比CT更为实时、便捷。根据腹主动脉瘤的声像图表现，我们将其分为：无回声型、混合回声型和膜状两腔回声型三类。结论：彩色多普勒超声对腹主动脉瘤的诊断与分型具有重要的临床诊断价值。     

Contrast-enhanced sonography for diagnosis of ruptured abdominal aortic aneurysm

OBJECTIVE: We describe the contrast-specific sonography features of ruptured abdominal aortic aneurysm, and we hypothesize that this technique would be useful for emergency imaging of patients with suspected aneurysm rupture. CONCLUSION: We used contrast-specific sonography to assess eight patients with ruptured abdominal aortic aneurysm. Five of these cases were correlated with CT findings. We found that contrast-enhanced sonography can reveal features specific for ruptured aortic aneurysm without causing a significant delay in surgery. This technique may be as effective as CT but may allow a more rapid and noninvasive diagnosis, especially when sonography can be performed bedside.     

Radiologic features and anatomic basis of atypical clinical presentations of ruptured abdominal aortic aneurysms

Ruptured abdominal aortic aneurysms (AAAs) occasionally manifest with atypical clinical presentations and can be initially misdiagnosed. Symptoms are attributable either to local mass effect from the aneurysm or a contained rupture, or to the particular cavity or anatomic space into which an aneurysm bleeds. Radiologic studies obtained in this patient population often will demonstrate signs of the ruptured AAA, and these signs should be actively searched for when a ruptured AAA can be in the differential diagnosis. Emergent computed tomographic examination is indicated to confirm any clinical or radiologic suspicion of a ruptured abdominal aortic aneurysm, provided that the patient remains hemodynamically stable. The anatomic basis for a ruptured AAA presenting clinically as renal colic is discussed and illustrated, and the spectrum of clinical presentations of ruptured AAAs is reviewed.     

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm. This work was supported in part by U.S. Public Health Service Grant No. HL07334.     

Acute epiploic appendagitis: CT findings in 33 cases

Acute epiploic appendagitis (AEA) is a benign self-limiting process presenting with acute abdominal pain often misdiagnosed clinically as either diverticulitis or appendicitis, but which has a pathognomonic CT appearance. The CT findings in 33 adult patients diagnosed by CT over a 33-month period as having AEA were retrospectively reviewed. The study group included 24 men and 9 women, with a mean age of 44.6 years. The mean age of the male patients was lower than that of the female patients, 40.9 vs 54.7 years. All patients presented with acute abdominal pain, mainly in the left (n=21) and right (n=9) lower quadrants, with localized tenderness in all patients and peritoneal irritation in 15 of them. Low-grade fever was found in 8 patients and mild leukocytosis in 16. Characteristic CT findings of an oval fatty mass with central streaky densities and surrounded by mesenteric stranding adjacent to the serosal surface of the colon were seen in all cases. Additional findings included mural thickening of the juxtaposed colon in 16 patients and peritoneal fluid in 7. One patient underwent surgery on the basis of an erroneous diagnosis of acute appendicitis. As CT is often used nowadays to evaluate various acute abdominal complaints, it may be the first imaging modality by which AEA is diagnosed. AEA should be included in the differential diagnosis in young male patients with localized left lower abdominal pain and tenderness. Electronic Publication     

Filling defect sign in CT diagnosis of ruptured aneurysm

We have encountered a ruptured aneurysm as a filling defect in cisternal blood on CT in patients with acute subarachnoid haemorrhage (SAH), as high-attenuation blood can act as a contrast medium. We term this finding the “filling defect sign”. To evaluate the usefulness of the sign in the diagnosis of a ruptured aneurysm, we retrospectively analysed CT with 10-mm-thick slices obtained within 2 days of onset of SAH in 100 consecutive patients. The sign was observed in 30 of the 100 patients, and in 13 (68 %) of 19 patients with a ruptured aneurysm more than 10 mm in diameter. The filling defect sign is useful in predicting the site of rupture. Received: 30 May 1996 Accepted: 6 September 1996