主动脉夹层CT平扫与CT血管造影的对比分析

目的:探讨CT平扫诊断主动脉夹层的临床应用价值,并与CT血管造影(CTA)进行对比。方法:回顾分析某医院2008年2月至2011年6月主动脉夹层32例。全部病例均行CT平扫后进一步行CTA检查(15例夜间急诊患者先行平扫后于次日进一步CTA检查,其余患者均平扫后紧接着行CTA检查),并进行比对。结果:32例主动脉夹层中21例典型主动脉夹层,11例不典型主动脉夹层(壁内血肿)。按Stanford分型,A型10例,B型22例。21例典型主动脉夹层中20例平扫可见撕裂内膜片,1例仅见主动脉增宽,增强可见内膜片分隔真假腔内均有对比剂进入,其中内膜钙斑随撕裂内膜移位2例。11例不典型主动脉夹层平扫见主动脉壁呈半月形或环形高密度增厚,厚度≥5 mm,增强血肿内无对比剂充盈,呈半月形或环形低密度影。其中7例内膜钙化内移,3例内膜渗漏,5例穿透性溃疡。该组病例中15例伴动脉粥样硬化改变,并发4例心包积液,24例胸腔积液。结论:主动脉夹层的确诊需要CT增强,但对于受各种条件所限,患者不能及时行CT增强时,CT平扫可以提示主动脉夹层存在,及时为临床的诊断治疗提供有价值的信息。

Comparative Study for Noncontrast CT Scan and CTA in Aortic Dissection

Objective To compare the value of noncontrast CT scan and CTA in the clinical application of aortic dissection. Methods Thirty-two cases of aortic dissection admitted in Xiaogan Central Hospital from February 2008 to June 2011 were retrospectively analyzed. All patients took CTA after CT scan and the results were compared, of which, 15 cases took emer- gency CT followed with CTA the next day, and other cases took CTA fight after noncontrast CT scan. Results Among 32 cases of aortic dissection, 21 ones were typical aortic dissection, 11 ones were atypical aortic dissection （intramural hematoma）. According to the Stanford classification, 10 cases were type A, 22cases were type B. In the 21 typical aortic dissection cases, 20 cases showed torn intima in CT scan, l case only presented aorta widen. CTA showed enhancement in both true and false lumen. 2 cases displayed calcification shifted with torn intima. In the 11 atypical aortic dissection cases, CT scan showed high density thickening of the aortic wall in semilunar or ring pattern, with a thickness of over 5 ram, the hematomas were unenhanced and appeared as semilunar or ring low density area, 7 cases were accompanied with intima calcification shift, 3 cases with intima leakage, 5 eases with penetrating ulcer. Among the 15 cases with atherosclerotic change, 4 cases showed pericardial effusion, 24 cases showed pleural effusion. Conclusion CTA is more specific for the di- agnosis of aortic dissection than uncontrast CT scan, however, uncontrast CT scan can provide valuable information for the diagnosis of aortic dissection, especially for emergency patients with limited time and condition for CTA.