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。

Imaging findings and clinical value of multiple-slice computed tomography angiography in acute aortic intramural hematoma

Objective To explore the imaging findings in and clinical value of multiple-slice computed tomography angiography (MSCTA) in acute aortic intramural hematoma (AAIH).Methods A total of 76 AAIH cases with complete clinical information were recruited and subjected to MSCTA examinations.The patients were divided into progressive and stable groups according to the follow-up changes.Then,the clinical data and MSCTA features were compared.All outcomes were analyzed statistically.The quantitative data of normal distribution and abnormal distribution were tested by two independent samples and Mann-Whitney U test,respectively.The qualitative data were tested by chi square test.Results A total of 27 (35.5％) type A cases and 49 (64.5％) type B cases were classified according to Stanford criteria.No significant difference in the maximum thickness of aortic hematoma,number of ulcer-like projections,degree of focal enhancement,and severity of pleural effusion was noted between the Stanford A and B groups (Z=-0.788,x2=0.441,x2=0.383,(x2=0.338,all P＞0.05).The ulcer depths in the Stanford A and B groups were (2.8 ± 2.9) and (2.5 ± 3.3) mm,respectively (Z =-2.345,P =0.019).Meanwhile,15 (19.7％) cases (12 type A cases and 3 type B cases) were accompanied by pericardial effusion (x2=16.138,P＜0.001).Twenty cases belonged to the progressive group,whereas 21 cases were included in the stable group.Univariate statistical analysis showed significant differences in ulcer-like projection,ulcer depth,and pleural effusion between the progressive and stable groups (x2=9.227,Z=-2.689,x2=4.111,all P＜0.05).By contrast,no significant difference in Stanford subtype,maximum aortic thickness,maximum aortic hematoma thickness,focal enhancement,and pleural effusion was noted between the Stanford A and B groups (x2=1.453,Z=-0.874,x2=0.006,x2=1.733,all P＞0.05).Multivariate analysis revealed that the amount of ulcer-like projections was the independent risk factor for AAIH progression.Conclusions AAIH manifested as annular and/or crescent thickening aortic wall with higher density in plain scan and non enhancement in enhanced scan using MSCTA technique.MSCTA plays an important role in the correct diagnosis of AAIH patients.The number of ulcer-like projections is the independent risk factor for disease progression.Close follow up is hence recommended during the early stage of AAIH using MSCTA.