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。     

颈部搏动性肿块的影像学诊断

目的探讨颈部搏动性肿块的影象学诊断价值,并着重分析其血管造影征象。材料与方法经病理和临床证实的颈部搏动性肿块患32例,其中颈动脉体瘤9例．动静脉瘘7例、颈动脉瘤5例．颈部假性动脉瘤3例．颈动脉迂曲症7例和巨大蔓状血管瘤1例。所有患均行选择性颈动脉造影,20例行血流超声检查．4例行CT检查、1例行MR检查、结果32例患中术前血管造影正确诊断31例,其中21例与病理结果相符,仅有1例假性动脉瘤误诊为真性动脉瘤;所有病变均显示其大小．起源和与周围大血管的关系。2例假性动脉瘤和5例颈动脉迂曲症彩超术前误诊为真性颈动脉瘤。结论选择性颈动脉造影足一种安全可靠的低创伤性影像学检查方法,结合其他影像学技术如彩超．CT、MR等口,准确做出定位和定性诊断。     

多层螺旋CT血管造影对主动脉假性动脉瘤诊断中的应用

目的：探讨多层螺旋CT血管造影（MSCTA）对主动脉假性动脉瘤的诊断价值。方法：对12例主动脉假性动脉瘤患者进行MSCT检查，将图像传至工作站进行后处理，运用不同的重建方法对血管进行显示，包括多平面重建（MPR）、最大密度投影（MIP）和容积显示（VR）技术。结果：12例主动脉假性动脉瘤MSCTA诊断均被手术或血管介入治疗证实。轴位图像与多种重建图像相结合能清晰地显示假性动脉瘤的解剖细节及其与周围器官的空间解剖关系。结论：MSCTA是一项简便、无创而有效的影像检查技术，对主动脉假性动脉瘤的临床诊断和治疗有重要价值。     

脉络膜恶性黑色素瘤的影像诊断(附31例分析)

目的：探讨脉络膜恶性黑色素瘤影像检查的诊断价值。方法：采用超声、眼底荧光血管造影、CT、MRI检查诊断脉络膜恶性黑色素瘤31例。其中超声与眼底荧光血管造影20例。超声与CT7例，超声与MRI4例。结果：B超及CT显示半圆形密度均等肿块，眼底荧光血管造影表现为斑点状渗漏并扩大，MRI示T1加权像中到高信号，T2加权像为低信号。结论：B超检查与眼底荧光血管造影或与CT、MRI的联合应用能充分显示脉络膜恶性黑色素瘤的影像特征，对脉络膜恶性黑色素的诊断具有重要的临床价值。     

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。     

彩色多普勒超声诊断四肢假性动脉瘤的价值

目的：探讨四肢假性动脉瘤的彩色多普勒超声特征及其诊断价值。材料和方法：回顾性分析31例经动脉造影／手术证实的四肢假性动脉瘤的彩色多普勒超声表现。结果：31例在受损动脉旁探及搏动性无回声或混合回声区，囊壁无正常动脉壁的3层结构。囊腔内可见五色镶嵌或红、蓝各半血流信号。囊腔通过破口与受损动脉相通，在破口处探及高速“双向双期”血流频谱。压迫病变近端动脉时囊瘤变小、彩色血流信号减弱。结论：彩色多普勒超声诊断假性动脉瘤准确、简便、无创，应作为首选检查方法。     

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.     

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     

腘动脉瘤的影像学表现及临床诊治

目的 探讨影像学在腘动脉瘤(popliteal artery aneurysms, PAA)诊断与治疗中的应用价值。方法 选取40例PAA患者的临床及影像资料，以手术和数字减影血管造影(DSA)结果为对照，评价影像学检查的准确性。结果 40例患者(54条患肢)的CTA和MRI检查均清晰显示瘤体大小、形态、数目、位置、密度或信号、PAA附壁血栓情况、瘤体与周围软组织关系。瘤体直径最小为15 mm,最大为138 mm,平均直径35 mm。38条患肢PAA合并血栓形成，3条患肢合并有腘动脉陷迫综合征(PAES),3条患肢为PAA破裂形成假性动脉瘤，11例患者合并有其他主动脉瘤。影像学结果与手术或DSA诊断结果一致。结论 CTA和MRI可以清晰显示瘤体形态、血栓有无、与周围软组织关系，对诊断PAA具有显著优势。     

多层螺旋CT血管造影在假性动脉瘤的诊断、治疗及随访中的应用

目的:探讨多层螺旋CT血管造影(MSCTA)在假性动脉瘤的诊断和治疗中的应用价值.材料和方法:对4例假性动脉瘤患者进行MSCTA检查,将获得图像进行多平面重建(MPVR),最大强度投影(MIP),容积再现(VR)技术后处理重建.结果:2例假性动脉瘤位于腹主动脉,1例位于肾动脉,1例位于小腿动脉.瘤体直径2.5～6cm.肿瘤呈类圆形,边缘毛糙.1例肿瘤边缘血栓形成.1例瘤体完全血栓机化.3例用MPVR技术良好显示母血管开口大小.结论:MSCTA是一种简便、经济、准确的检查方法,能有效的显示假性动脉瘤的形态特征和动脉受损部位以及母血管开口大小,对临床诊断和选择治疗方法,以及治疗后的效果随访有重要价值.     

应用国产覆膜支架治疗Stanford B型主动脉夹层动脉瘤

目的:评价应用国产覆膜支架治疗B型主动脉夹层动脉瘤的安全性及临床疗效.方法:自2005 - 05～2009 - 12对38例Stanford B型主动脉夹层动脉瘤实施了腔内隔绝术.其中男29例,女9例;年龄(54±12)岁.经CT增强扫描或磁共振成像(MRJ)确诊.切开左或右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,随访行CT或MRI检查.结果:支架置入全部成功,术后即刻造影36例无内漏,2例见少量内漏.降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有不同程度改善.住院期间及随访1年内无患者死亡,发生主动脉腔内隔绝术后综合征3例.结论:应用国产覆膜支架腔内隔绝治疗B型主动脉夹层动脉瘤是一种操作简便、安全、成功率高、并发症少,疗效可靠的介入方法.     

Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma

The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting and managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; and extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal hematoma on CT scans was considered an indirect sign of ATAI: In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: Among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal hematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela based on clinical and radiographic criteria. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations to confirm the diagnosis: Isolated aortic bands or contour vessel abnormalities should be first considered as possible artifacts or related to non-traumatic etiologies especially when mediastinal hematoma is absent. In cases of isolated mediastinal hematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography.     

Mycotic aneurysms of the aorta: radiologic features

Four patients with a total of six mycotic aneurysms of the aorta were examined with computed tomography (CT) after intravenous contrast material enhancement, and with abdominal or thoracic aortography. In the three patients with mycotic aneurysms involving the abdominal aorta, CT scans showed a vascular paraaortic structure without calcified walls adjacent to a nondilated aorta, and a large non-contrast-enhanced retroperitoneal mass representing inflammatory tissue and blood from a contained aortic rupture. A CT scan of one aneurysm of the thoracic aorta demonstrated an enhanced saccular mass originating from the aorta without paraspinal component. In three of four patients, the CT findings were corroborated by aortographic evidence of an eccentric aneurysmal sac in an atypical location for atheromatous disease. In four patients with clinical manifestations suggesting mycotic aneurysm of the aorta, a combination of CT and angiographic imaging provided accurate diagnostic information for planning adequate and early surgical treatment.     

主动脉瘤的血管内支架治疗

作者对１例胸腹主动脉瘤（假性）伴后纵隔和腹膜后血肿患者作了密集网格式镍钛合金内支架治疗。经股动脉入路，用１２Ｆ导管将直径２０ｍｍ、长９０ｍｍ内支架跨靶病灶放置，另一直径２４ｍｍ、长５０ｍｍ内支架则用于加固前者。术后即刻造影示动脉瘤被部分隔离；２周后ＣＴ和造影随访显示：瘤腔被完全隔离，主动脉狭窄和受压移位消失，所有分支血管完全畅通，支架无移位。临床随访至今８周未出现腹痛复发，围手术期亦未发生严重并发     

主动脉壁内血肿的影像学诊断

目的 分析总结主动脉壁内血肿(AIH)的影像学特点。资料与方法 回顾8例影像学资料完整的AIH病例，分析其胸部X线平片、CT、MRI及血管造影特点。结果 8例AIH，1例累及升主动脉根部至腹主动脉远端，1例累及主动脉弓及降主动脉，6例累及降主动脉和／或腹主动脉，其中2例为降主动脉近中段动脉粥样硬化斑块穿通溃疡(PAU)形成局部AIH。胸部X线平片、增强CT、MRI及血管造影均可见阳性征象，CT、MRI直接观察到病变程度及累及的范围。结论 CT和MRI是确诊AIH的最主要检查手段。     

Aorta and iliac arteries: single versus multiple detector-row helical CT angiography

PURPOSE: To compare single- versus four-channel helical computed tomographic (CT) aortography. MATERIALS AND METHODS: Forty-eight patients with aortic aneurysm or dissection underwent four- and one-channel CT angiography. Scan pairs covered the thoracic inlet to the diaphragm (n = 10) and supraceliac abdominal aorta (n = 19) or thoracic inlet (n = 19) to the femoral arterial bifurcations. For four-channel CT, nominal section thickness and pitch were 2.5 mm and 6.0, respectively, and for one-channel CT, 3.0 mm and 2.0 to the infrarenal aorta and 5.0 mm and 2.0 to the femoral arteries. Effective section thickness, scanning duration, scanning coverage, dose of iodinated contrast material, and mean aortoiliac attenuation were compared. Data were summarized as speed (coverage/duration), scanning efficiency (speed/section thickness), and contrast efficiency (mean aortic attenuation/dose of contrast material). RESULTS: At four- versus one-channel CT, CT angiography was 2.6 times faster, scanning efficiency was 4.1 times greater, contrast efficiency was 2.5 times greater, dose of contrast material was reduced (mean, 57%; 97 vs 232 mL) without a significant change in aortic enhancement, and sections were thinner (mean, 40%; 3.2 vs 5.3 mm) despite a 59% shorter scanning duration (22 vs 56 seconds). CONCLUSION: Substantially reduced doses of contrast medium, shorter scanning durations, and narrower effective sections result with four- versus one-channel CT aortography. No advantages of one-channel CT aortography were demonstrated.     

Synthetic interposition grafts of the thoracic aorta: postoperative appearance on serial CT studies

PURPOSE: To determine the normal postoperative appearance of thoracic aortic interposition grafts on serial CT studies and to document CT detectable complications. MATERIALS AND METHODS: The 235 CT studies in 114 patients with one or more thoracic aortic interposition grafts were analyzed for the presence or absence of felt rings, felt pledgets, low-attenuation material surrounding the graft, pseudoaneurysm, and dissection flap. A graft was present in the ascending aorta in 93 patients, in the descending aorta in 25, and in the arch in 11. RESULTS: Low-attenuation material was seen adjacent to the ascending graft in 55%-82% of patients and adjacent to the descending graft in 60%-79% of patients, showing diminishing frequency and thickness over time. CT scans in 30 of 53 patients showed residual low-attenuation material adjacent to the graft more than 1 year after surgery. CT scans in four of 93 patients with ascending grafts and one of 25 patients with descending grafts showed a pseudoaneurysm. CONCLUSION: CT studies obtained after aortic interposition grafting show characteristic findings. Knowledge of the type of operative procedure and typical location and CT appearance of surgical materials used is important to correctly diagnose or exclude postoperative complications following thoracic aortic interposition grafting.     

Acute disease of the aorta. Diagnosis by computed tomography and ultrasonography

CT and ultrasonography, alone or in combination, have partially replaced aortography for the detection of abnormalities of the native and grafted abdominal aorta. In our medical center, ultrasonography is used to detect or confirm the diagnosis of aortic aneurysm and to determine its size, extent, and relationship to the renal arteries. We usually choose CT to assess suspected rupture of the native aorta and complications of the grafted aorta, such as occlusion, leakage, false aneurysm, or perigraft infection. Acute disease of the abdominal aorta can be detected or excluded using these relatively noninvasive imaging techniques.     

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.     

Computed tomography in the diagnosis of traumatic rupture of the thoracic aorta

Over a 26-month period, 25 patients admitted to the Trauma Unit at UCSD Medical Center following blunt trauma were investigated for suspected traumatic rupture of the thoracic aorta by computed tomography (CT) of the chest. A retrospective review of these patients was performed. Twenty-one (84%) also had CT of other body areas, most commonly the head or abdomen. Nine of the 25 patients subsequently had aortography; in 15 patients the CT findings were felt at the time to exclude rupture, and one patient was not investigated further because of severe head injuries. In general, if CT failed to show a mediastinal haematoma, aortography was not performed. However, five patients with CT evidence of a haematoma, including two with vertebral fractures, were not investigated by aortography. Two of the 25 patients (8%) had angiographically proven aortic ruptures; in both CT had shown not only a haematoma but also an abnormal outline of the aorta on contrast-enhanced scans. The haematoma was large in one patient and small in the other. Although 10 of the 25 patients had unenhanced scans, no case of aortic rupture is known to have been missed. During the same study period, 47 patients were investigated for suspected aortic rupture solely by aortography. Four patients (8% of this group) had aortic rupture, and two had subclavian or innominate artery ruptures. Only a minority (approximately one-quarter) also had CT of the head or abdomen. The role of CT in the diagnosis of traumatic rupture of the aorta is critically assessed in the light of our experience and a review of the literature.