多层螺旋CT血管成像在腹主动脉瘤中的诊断应用

目的探讨多层螺旋CT血管成像在腹主动脉瘤（AAA）中的诊断价值。方法30例临床疑诊AAA患者均经16层螺旋CT血管成像（MSCTA）。采用最大密度投影（M1P）、多平面重组（MPR）、容积再现（VR）技术对传送至AW4.1工作站的原始数据进行重建,获得二维或三维的立体图像。结果30例疑诊AAA患者中有7例真性腹主动脉瘤,15例假性动脉瘤,8例主动脉夹层。MPR能准确显示瘤体位置、形态、范围及附壁血栓。MIP能较好地显示瘤壁及附壁血栓内的钙化。VR技术能立体精确显示腹主动脉、瘤体及周围组织结构的空间关系。结论多层螺旋CT血管成像是一种无创、快速的检查方法,为临床诊断、治疗腹主动脉瘤提供重要信息。     

16层螺旋CT在腹主动脉瘤中的诊断应用

目的 探讨16层螺旋CT对腹主动脉瘤的诊断价值.方法 对40例腹主动脉瘤患者进行16层螺旋CT扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)图像重组.结果 CT显示腹主动脉呈囊状扩张7例、梭形扩张23例、囊梭形扩张10例.其中多发性腹主动脉瘤3例,并发假性动脉瘤1例.MPR准确显示瘤体的位置、形态、范围及瘤腔内附壁血栓,MIP较好地显示瘤壁或附壁血栓内的钙化,VR以三维形式精确显示瘤体与邻近腹主动脉及其与分支血管的关系.结论 16层螺旋CT是腹主动脉瘤诊断、随诊观察和术后随访最理想的影像技术.     

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。     

彩色多普勒超声在腹主动脉瘤诊断中的临床应用价值

目的探讨彩色多普勒超声在腹主动脉瘤诊断中的应用价值。方法分析了在我院经腹部彩色多普勒超声检查发现的25例腹主动脉瘤患者的临床表现及影像学资料。结果 1)临床表现:25例患者中出现搏动性腹部包块18例,5例存在消化道不适症状,2例因剧烈腹部疼痛就诊;2)病理分类:本组25例腹主动脉瘤患者中真性动脉瘤12例,假性动脉瘤5例,夹层动脉瘤8例;3)彩色多普勒超声表现:在12例真性动脉瘤患者中瘤壁附有血栓5例。结论彩色多普勒超声检查可准确地诊断腹主动脉瘤,而且还被用于临床病例的动态观察,具有价格低廉、准确和重复性好等优势。     

64层螺旋CT在主动脉假性动脉瘤中的应用

目的 探讨64层螺旋CT对主动脉假性动脉瘤的诊断价值.资料与方法主动脉假性动脉瘤患者29例,男16例,女13例,年龄35～68岁,平均56岁.均行64层螺旋CT扫描,并将扫描原始数据采用容积再现(VR)、最大密度投影(MIP)、多平面蓖组(MPR)处理.结果 VR明确显示动脉瘤的范围和周围血管的关系;MPR对瘤体内附壁血栓范围的显示较佳;而MIP对瘤壁的钙化及对管腔各段的精确测量颇有价值.结论 64层螺旋CT是主动脉假性动脉瘤诊断、随诊观察和术后随访较理想的影像技术.     

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。     

多层螺旋CT对腹膜假性黏液瘤的诊断价值

目的 探讨腹膜假性黏液瘤的MSCT表现.方法 搜集经手术、病理证实的腹膜假性黏液瘤11例,回顾性分析其CT表现.结果 腹膜假性黏液瘤的MSCT平扫见腹腔不规则囊实性肿块,CT值18.5～27.6 HU;肝脾等实质脏器边缘扇贝样或结节状压迹,脏器周围、网膜间隙、腹腔、盆腔见大量黏液性腹水;腹膜、大小网膜弥漫性不规则增厚;增强扫描显示囊实性病变仅见囊壁、网膜、腹膜轻度强化,囊内病灶无明显强化.结论 MSCT检查对该病的诊断及鉴别诊断具有重要的价值.     

螺旋CT血管造影在腹主动脉瘤诊断中的应用

目的 :评价螺旋 CT血管造影 (SCTA)在腹主动脉瘤诊断中的价值。方法 :13例腹主动脉瘤病人行螺旋 CT增强扫描 ,后进行各种重建 :表面阴影显示 (SSD)、多平面重建 (MPR)、最大密度投影 (MIP)。结果 :SSD明确显示动脉瘤的范围和周围血管的关系 ;MPR对瘤体内附壁血栓范围的显示较佳 ;而 MIP对瘤壁的钙化及对管腔各段的精确测量颇有价值。结论 :螺旋 CT血管造影操作简单、安全、诊断明确 ,能帮助和指导手术 ,可取代 DSA对腹主动脉瘤的诊断     

MRI对主动脉瘤的诊断价值(附49例分析)

目的　探讨MRI对主动脉真性动脉瘤、主动脉夹层及假性动脉瘤的诊断价值。方法　 49例主动脉瘤 ,其中真性动脉瘤2 0例 ,主动脉夹层 2 6例 ,假性动脉瘤 3例。全部病例均采用MRISE常规序列 ,9例采用FFE序列电影成像。结果　本组病例均直观显示病变的部位、范围、形态 ,可直接测量主动脉瘤瘤体大小。 2 6例主动脉夹层均显示特有的双腔征 ,18例显示内膜片 ,7例显示内膜撕裂口。 9例患者 (真性动脉瘤 1例 ,主动脉夹层 8例 )共 2 0支分支血管受累。结论　MRI能清晰显示主动脉瘤和瘤体内结构 ,是诊断主动脉病变的最佳影像学方法之一     

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.     

CT of aortic aneurysms: the distinction between mural and thrombus calcification

Aortic calcification, either mural or thrombus, is a common finding in patients with abdominal aortic aneurysms. Differentiating between the two sites of calcification is necessary in order to avoid confusing simple thrombus calcification with displaced calcified intima in aortic dissection. The CT scans of 145 cases of abdominal aortic aneurysm and seven cases of abdominal aortic aneurysm with dissection were analyzed with respect to the location of the calcification: mural only or mural and thrombus. Mural calcification was seen in all 152 patients with aneurysms whereas thrombus calcification was identified in only 33 (24%) of the 136 patients with thrombus. Displaced intimal calcification caused by aortic dissection can either appear similar to or, at times, be indistinguishable from thrombus calcification. Thrombus calcification was present in four (57%) of the seven patients with abdominal aortic aneurysms and dissection. To avoid the possibility of a false-positive diagnosis of aortic dissection in patients with abdominal aortic aneurysm, other signs of aortic dissection should be sought such as separation of the true and false lumina by an intimal flap.     

主动脉病变螺旋CT三维成像的临床应用

目的　探讨螺旋CT在主动脉疾病诊断中的临床应用及其价值。　材料与方法　22例主动脉疾病（11例主动脉瘤、1例胸主动脉假性动脉瘤、7例主动脉夹层动脉瘤、1例大动脉炎、2例主动脉缩窄）者行螺旋CT增强检查,以表面覆盖显示(SSD)、多平面重建(MPR)、最大密度投影(MIP)、血管CT仿真内窥镜成像(CTVE)等多种方式重建。　结果　SSD均能很好显示病变的全貌,动脉瘤的大小、范围,夹层内膜片及与分支血管的关系等;MPR可较好显示附壁血栓,真假腔和内膜片;MIP可清楚显示管壁钙化和动脉瘤形态;CTVE可清晰显示内膜片、真假腔及血管的狭窄。　结论　诊断主动脉疾病综合应用螺旋CT的各种技术可基本取代X线血管造影,其为临床提供了一种可靠的诊断手段。     

特殊类型主动脉夹层的电子束CT表现及诊断

目的探讨表现特殊的主动脉夹层的电子束CT(EBCT)影像特征及诊断.材料和方法20例表现特殊的主动脉夹层,其中不典型夹层13例,三腔以上夹层动脉瘤3例,合并升主动脉壁内血肿的Stanford B型夹层2例,动脉瘤样夹层1例,外伤性主动脉夹层1例.结果主动脉不典型夹层为主动脉壁新月形或环形的低密度血肿包绕,常可见穿透性溃疡或钙化内移等征象;三腔以上夹层动脉瘤有2～3个内膜片,3～4个腔,瘤体管径较大;合并升主动脉壁内血肿的B型夹层见升主动脉管壁低密度新月形或环形增厚,降主动脉则见内膜片及真假两腔形成;动脉瘤样主动脉夹层见降主动脉局限性瘤样扩张,破口大,内膜片不易发现.1例外伤性夹层于主动脉弓峡部及降部起始见破裂内膜片.结论特殊类型的主动脉夹层表现各具特征,EBCT可清晰显示,是极适用于胸部急症的快速、无创的检查方法.     

多层螺旋CT对主动脉夹层动脉瘤的诊断价值

目的探讨多层螺旋CT对主动脉动脉瘤的诊断价值。方法对25例主动脉瘤患者于临床症状出现后进行多层螺旋CT平扫加增强扫描并利用原始数据在AW4．3工作站进行MPR及VR后处理。结果横轴位图像上可观察到真假腔形态、大小、剥脱的内膜片、破口位置及内膜和主动脉壁钙化,MPR重建图像能观察主动脉弓受累情况,确定内膜剥离范围,显示内膜与各分支血管之间的关系,按DeBakey分型,本组患者表现为Ⅰ型4例,Ⅱ型2例,Ⅲ型19例。结论多层螺旋CT能直观、立体显示真、假腔的形态、大小,破口位置及其与大分支血管的关系,因而它应是诊断夹层动脉瘤的首选检查方法。     

血管源性急腹症多层螺旋CT诊断价值

目的探讨以急性腹痛为主要表现的血管源性疾病的多层螺旋CT表现及诊断价值。方法回顾性分析经临床或手术确诊的35例血管源性急腹症的CT表现,包括平扫和增强扫描及利用多种图像后处理技术重建的图像,如多平面重建法（MPR）、曲面重建法（CPR）、最大密度投影法（MIP）、容积成像法（VR）、表面遮盖法（SSD）进行血管成像。结果肠系膜上静脉、门静脉及脾静脉血栓13例,夹层动脉瘤10例,肠系膜扭转伴肠梗阻3例,腹部动脉瘤3例,外伤致肠系膜血肿3例,腹部动脉血栓3例。结论多层螺旋CT平扫联合增强扫描,结合多种图像后处理技术能快速显示血管源性急腹症的病因、部位及范围,可作为首选的影像学检查方法。     

Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

Objectives

Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol.

Methods

Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women’s Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0–3.8 years.

Results

One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention.

Conclusions

AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study.

Key Points

? The association of calcification and thrombus volumes with EVAR outcome is unclear ? Quantifiable methods for assessing calcification and thrombus were not used previously ? This study used reproducible methods for assessing AAA calcification and thrombus volumes     

不典型主动脉夹层的多层螺旋CT诊断价值

目的:回顾性分析不典型主动脉夹层(atypical aortic dissection,AAD)的CT表现,探讨螺旋CT诊断AAD的价值。方法:25例AAD患者,全部行平扫及增强扫描,并结合多平面重组、曲面重组等方法显示AAD及穿透溃疡,根据Stan-ford分类法分型。结果:25例AAD,A型7例,B型18例。主要CT表现:主动脉壁呈新月型或环形增厚,无内膜破裂形成的双腔主动脉征象,增强扫描假腔无强化。内膜钙化向内移位7例,穿透性溃疡征3例。并发心包、纵隔及胸腔积液和积血共10例。经内科保守治疗后,6例完全吸收,3例部分不典型吸收,2例无明显变化。结论:螺旋CT清楚显示夹层的部位、范围及并发症,可作为主动脉夹层的首选检查及随访方法。     

Inflammatory abdominal aortic aneurysm: a cause of urinary obstruction and acute renal failure

Abdominal aortic aneurysms are rare causes of ureteric obstruction. We report three cases of inflammatory abdominal aortic aneurysm producing hydronephrosis. In two patients acute renal failure preceded this presentation. The diagnosis can be established by computed tomography when mural thrombus, wall calcification, and an enhancing periaortic soft-tissue mantle are present. It is important to recognize this disease preoperatively.     

Measurement and determinants of infrarenal aortic thrombus volume

Intra-luminal thrombus has been suggested to play a role in the progression of abdominal aortic aneurysm (AAA). The aims of this study were twofold. Firstly, to assess the reproducibility of a computer tomography (CT)-based technique for measurement of aortic thrombus volume. Secondly, to examine the determinants of infrarenal aortic thrombus volume in a cohort of patients with aortic dilatation. A consecutive series of 75 patients assessed by CT angiography with maximum aortic diameter >/=25 mm were recruited. Intra-luminal thrombus volume was measured by a semi-automated workstation protocol based on a previously defined technique to quantitate aortic calcification. Intra- and inter-observer reproducibility were assessed using correlation coefficients, coefficient of variation and Bland-Altman plots. Infrarenal aortic thrombus volume percentage was related to clinical, anatomical and blood characteristics of the patients using univariate and multivariate tests. Infrarenal aortic thrombus volume was related to the severity of aortic dilatation assessed by total aortic volume (r = 0.87, P < 0.0001) or maximum aortic diameter (r = 0.74, P < 0.0001). We therefore examined the clinical determinates of aortic thrombus expressed as a percentage of total aortic volume. Aortic thrombus percentage was negatively correlated with serum high density lipoprotein (HDL, r = -0.31). By ordinal multiple logistic regression analysis serum HDL below median (相似文献