急性主动脉综合征的MDCT评价

目的 评估多层螺旋CT对急性主动脉综合征(AAS)的诊断价值.方法 搜集2015年1月至2016年1月行主动脉CTA的AAS患者29例,对CTA的图像特征进行回顾性分析,并计算CT辐射剂量.结果 29例AAS中,主动脉夹层12例,主动脉溃疡5例,主动脉壁内血肿7例,不稳定动脉瘤5例.12例主动脉夹层中,A型和B型分别占41.7％ (5/12)和58.3％(7/12),7例主动脉壁内血肿A型和B型分别占42.8％ (3/7)和57.2％(4/7).CTA的平均辐射剂量为(9.08±1.83) mSv.结论 CTA能清晰显示AAS的影像特征,在诊断AAS中有重要临床价值.     

急性主动脉综合征的CT和MRI表现

急性主动脉综合征(AAS)包括主动脉夹层(AD)、壁内血肿(IMH)和穿透性动脉粥样硬化性溃疡(PAU),是严重威胁人类生命的综合征,其临床诊断困难。CT和MRI技术迅速发展,成为AAS诊断和鉴别诊断的重要方法,可为临床制定正确的治疗方案、判断预后和评估疗效提供重要信息。就AAS的定义、病因、分型、自然病程、CT和MRI表现进行综述。     

主动脉壁内血肿的CT诊断应用

目的 探讨多层螺旋CT对主动脉壁内血肿的诊断价值.方法 收集35例主动脉壁内血肿患者的CT检查资料,通过后处理工作站,进行多平面重组、曲面重组,最大密度投影、容积再现等处理,观察图像,分析结果.结果 35例患者中DeBaKey分型Ⅰ型8例,Ⅱ型2例,Ⅲ型25例;其中11例内膜钙化斑内移,9例穿透性溃疡,6例并发心包积液,15例胸腔积液.结论 64层螺旋CT以快速、无创的方法清晰显示主动脉壁内血肿的位置、范围及其他并发征象,对临床的诊断与治疗提供巨大帮助.     

主动脉壁内血肿的64层螺旋CT诊断价值

目的：评价64层螺旋CT对主动脉壁内血肿的价值及优势。方法：采用64层螺旋CT,连续容积增强扫描,对32例主诉急性胸背痛患者行CT检查并诊断为壁内血肿。结果：32例按Stanford分型：A型8例,B型24例。其直接征象：沿主动脉壁的环形或新月形低密度影,无撕裂的内膜片。间接征象：钙化的动脉壁内移10例,溃疡18例,主动脉粥样硬化改变8例。并发胸腔积液3例。结论：螺旋CT血管成像技术可以在无创或微创的情况下清晰地显示壁内血肿,为临床诊断和治疗提供有价值的依据。     

主动脉不典型夹层转归的电子束CT研究

目的 电子束CT（EBCT）评价主动脉不典型夹层（或称为壁内血肿，IMH）的动态变化过程。方法 回顾分析2002年1月至2004年9月，23例经临床及EBCT诊断的主动脉IMH患者，均以胸痛或腹痛入院，21例为1-14d的急性IMH，〉14d的慢性IMH患者2例。患者EBCT检查≥2次，男19例，女4例，年龄30-81岁，平均57．78岁，随访时间4-405d（平均105．84d）。采用Imatron C-150XP型EBCT扫描机，连续容积增强扫描，层厚6mm，床进3．5mm或层厚3mm，床进3mm，扫描时间为0．1s。扫描范围自主动脉弓水平至左、右髂动脉分叉处，共140层。结果 4例A型IMH，其中3例分别于1．0、1．5、4．0个月完全吸收，1例无明显变化。19例B型IMH患者，完全吸收9例，部分吸收4例；无变化4例；进展2例，其中1例进展为真性动脉瘤。患者4-15d内短期随访血肿变化不明显或有加重，15-30d壁内血肿明显吸收，但溃疡随时间延长加重。结论 EBCT可作为IMH患者定期随访的检查，且根据病变的影像学特点提出最佳的治疗方案。     

主动脉壁内血肿的64层螺旋CT诊断

目的：探讨64层螺旋CT诊断主动脉壁内血肿（AIH）的价值。方法：对25例主诉急性胸背痛患者进行64层螺旋CT检查（连续容积扫描）,均经临床及影像学检查诊断为主动脉壁内血肿。结果：25例AIH患者按Stanford分型,A型2例,B型23例。MSCT征象：25例均见主动脉壁呈新月形或环形增厚,厚度≥5mm,无内膜破裂形成的双腔主动脉征象。平扫呈高密度11例,高密度为主的混杂密度8例,等密度6例。21例见钙化内移征象,5例可见穿透性溃疡征,动脉粥样硬化性改变18例,内膜渗透3例,血肿分层征象2例。并发心包积液4例,胸腔积液16例,主动脉夹层3例,主动脉瘤2例。结论：MSCT能为主动脉壁内血肿的诊断和治疗提供重要信息,且便于治疗后随访观察,可以作为AIH的首选诊断及随访检查方法。     

多层螺旋CT对主动脉壁内血肿的诊断价值

目的:评价多层螺旋CT诊断主动脉壁内血肿的价值.方法:14例主动脉壁内血肿患者采用多层螺旋CT进行平扫及增强扫描并结合多模式重组如多平面重建、曲面重建等方法显示壁内血肿及穿透溃疡,并参照Stanford分类法进行分型.结果:14例主动脉壁内血肿,2例为A型,12例B型.主要CT表现:①全部病例均见主动脉壁呈半月形或环形增厚,CT平扫时呈高密度,增强后无强化;②内膜钙化向内移位6例;③并发心包、胸腔积液共11例.在多平面重建、曲面重建成像技术中14例均清晰显示血肿部位、厚度、累及范围及有无并发症.结论:多层螺旋CT并结合重组技术能提高诊断主动脉壁内血肿的准确性,具有重要的诊断价值及临床应用价值.     

主动脉壁内血肿的16层CT诊断

目的：探讨16层螺旋CT对主动脉壁内血肿（IMH）的诊断价值。方法：42例患者以急性主动脉综合征就诊;3例患者以慢性病史就诊,CT增强检查使用对比剂示踪技术,运用多平面重建、最大密度投影、容积重建、仿真内镜等重建方法,结合轴位图像,分析45例IMH的部位、形态、有无溃疡及胸腔积液等。结果：单纯性IMH9例,表现为沿主动脉壁的环状或新月形稍高密度影,增强后没有强化,主动脉内壁光滑;渍疡性IMH36例,溃疡呈乳头状16例,蘑菇状8例,楔形2例,不规则型7例,花瓣状3例。24例溃疡周围有较明显粥样斑块和钙化灶,12例无粥样斑块和钙化灶。9例IMH仅1例有少量胸腔积液,30例溃疡性IMH合并中量以上胸腔积液,单纯性和溃疡性IMH胸腔积液的程度和出现率比较,差异有统计学意义。结论：16层螺旋CT能够反映IMH影像学特点,可作为急诊首选检查方法。     

穿透性粥样硬化性主动脉溃疡的MSCTA表现

目的 探讨穿透性粥样硬化性主动脉溃疡（PAU）的多层螺旋CT血管造影（MSCTA）表现,进一步提高对本病的认识. 资料与方法 搜集我院行MSCTA的PAU15例,以横轴位CT为主,结合二维及三维重组对PAU的部位,大小及合并征象进行分析. 结果 15例共17个病灶.均表现为主动脉壁上的溃疡状突起,龛影口部与主动脉腔相连,可表现＂狭颈征＂,尤其在曲面重组（CPR）图像上明显.伴有局部或弥漫性主动脉壁内血肿（IMH）.间接征象包括主动脉壁钙化斑块、主动脉扩张等. 结论 MSCTA上主动脉溃疡伴随局限或广泛的IMH者均可诊断为PAU,MSCTA为诊断PAU的有力工具,诊断应以薄层横轴位和CPR图像为主,容积再现（VR）图像为辅.     

Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes

Acute aortic syndrome (AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection (AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT (MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., “beak sign”, aortic “cobwebs” that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the right diagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.     

急性壁间血肿合并穿透性主动脉溃疡的MSCTA诊断

目的评价多层螺旋CT血管造影(MSCTA)技术在急性壁间血肿合并穿透性溃疡的临床应用价值。方法对20例急性壁间血肿合并穿透性溃疡患者行MSCTA检查,结合二维和三维重建技术进行图像分析。结果按照Stanford分型,A型:5例,B型:15例。所有病例均未显示真假腔及撕裂内膜片,均合并主动脉穿透性溃疡。主动脉壁间血肿(aortic intramural hematoma,IMH)表现为主动脉壁"环"形或"新月"形增厚,伴钙化内膜内移12例,胸腔积液8例,心包积液4例。穿透性溃疡20例共28个病灶,表现为主动脉壁上的溃疡样突起(ulcerlike pro-jection,ULP),其中穿透性主动脉粥样硬化性溃疡(penetrating atherosclerotic ulcer,PAU)14例共22个(79%)病灶,6个(21%)ULP病灶均单发。结论 MSCTA是一种有效、无创的诊断急性壁间血肿合并穿透性溃疡的检查方法,能为临床诊断和治疗提供重要信息。     

Atherosclerotic penetrating ulcer of the aorta: typical morphology on CT. A review of five cases

Multiple penetrating atherosclerotic ulcers of the abdominal and thoracic aorta were detected in five elderly patients with well-known cardiovascular risk factors who were referred to our department for the investigation of an unrelated disease or acute chest pain. Penetrating ulcers of the aorta are defined as atherosclerotic intimal aortic plaques that ulcerate and penetrate into the media, allowing haematoma formation within the media. The progression of the disease is often limited by the presence of an associated fibrosis within the aortic media (medial fibrosis), but secondary formation of a pseudoaneurysm or very rarely a spontaneous perforation into the pleural space, mediastinum or peritoneal cavity have been observed. In our restrospective study we describe the morphology of the penetrating aortic ulcer on CT and in one case on sonography and angiography. A review of the literature is included.     

急性主动脉壁间血肿的多层螺旋CT血管造影影像学表现和诊断价值

目的探讨急性主动脉壁间血肿（AAIH）的多层螺旋CT血管造影（MSCTA）影像学特征和临床应用价值。方法回顾性分析临床确诊76例AAIH患者的主动脉MSCTA检查资料,依据Stanford分型分为A型和B型,比较不同Stanford分型AAIH的影像学表现有无差异。根据患者随访期间的不同变化分为进展组与稳定和缓解组,分析进展的相关因素。所有结果均行统计学分析,符合正态分布的定量资料采用两独立样本t检验;不符合正态分布的定量资料采用Mann-Whitney U检验。定性资料采用χ2检验。结果Stanford A型27例（35.5%）、B型49例（64.5%）。A型、B型壁间血肿最大厚度、溃疡类病变、局灶性强化、胸腔积液上的差异均无统计学意义（Z=-0.788、χ2=0.441、χ2=0.383、χ2=0.338,均P > 0.05）。A型、B型溃疡类病变的深度分别为（2.8±2.9）mm、（2.5±3.3）mm,差异有统计学意义（Z=-2.345,P=0.019）。心包积液15例（19.7%）,A型12例多于B型3例,差异有统计学意义（χ2=16.138,P < 0.001）。41例AAIH患者短期随访,进展组20例,稳定和缓解组21例。单因素分析显示,进展组与稳定和缓解组在溃疡类病变、溃疡深度、胸腔积液间的差异均具有统计学意义（χ2=9.227、Z=-2.689、χ2=4.111,均P < 0.05）;在Stanford分型、壁间血肿厚度、局灶性强化、心包积液上的差异均无统计学意义（χ2=1.453、Z=-0.874、χ2=0.006、χ2=1.733,均P > 0.05）。将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析,显示溃疡类病变是影响AAIH的独立危险预测因子。结论AAIH在MSCTA上表现为平扫密度较高、增强无强化的环形或新月形增厚主动脉管壁。MSCTA检查可以对AAIH做出快速、准确诊断。溃疡性病变是影响AAIH进展的独立危险因素。AAIH早期需要密切随访,监测有无进展。     

Acute aortic syndromes: Role of multi-detector row CT

Acute thoracic aortic syndromes encompass a spectrum of emergencies including aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and aneurysm rupture. All these life-threatening conditions require prompt diagnosis and appropriate management. To date multi-detector row Computed Tomography represents a valuable diagnostic tool especially in the emergency setting. This paper focus on the use of multi-detector row Computed Tomography in the evaluation of acute thoracic aortic syndromes and illustrates the key imaging findings related to each disease.     

Imaging of aortic dissection by helical computed tomography (CT)

Aortic dissection is the most frequent cause of aortic emergency, and its outcome is still frequently fatal. The management of this pathology has changed with the development of endovascular means. Nowadays, imaging modalities are helpful in management decision-making by providing information such as identification of entry tears along the aorta and involvement of the visceral branches of the abdominal aorta. Multi-slice CT scanning now appears to be the modality of choice for complete examination of the entire aorta. We review the parameters of image acquisition and contrast injection; appearances on CT of acute and chronic dissection are illustrated. Diagnostic pitfalls in CT imaging of acute dissection are discussed. Imaging of the post-surgical aorta and of chronic dissection is outlined. Intra-mural hematoma and penetrating aortic ulcer are subtypes of aortic dissection, and their appearances on CT scanning are also presented.     

急性胰腺炎预后的CT研究进展

急性胰腺炎(AP)早期是诊断与治疗的关键时期,早期影像诊断可对预后进行推测并判断一些重要并发症出现的可能性。目前,CT检查为早期AP最重要的影像检查技术,已建立多种评分系统进行AP严重度的评估,其中应用最广泛的是CT严重度指数(CTSI)及修订的CTSI(MCTSI)。CT评分可较好地预测预后,甚至判断是否出现器官衰竭。CECT所见的低强化及CTP显示的灌注减低是预示胰腺梗死的较好指标,但CT难以预测AP是否出现血管并发症及合并感染。