螺旋CT诊断主动脉夹层

目的提高对螺旋CT诊断主动脉夹层的认识。方法回顾性总结分析20例主动脉夹层病例，包括临床表现、影像学检查。所有患者均采用西门子16排螺旋CT机扫描，胸腹部平扫加增强扫描，据病变类型及范围决定扫描范围。结果全部患者均有胸痛，病程1h～5年。伴胸闷、气急者3例，1例有心悸，2例有背痛，1例有上腹痛，1例伴有声嘶、呼吸困难（考虑增粗主动脉压迫食管神经所致）。影像学多表现为主动脉增粗，可见真假二腔，假腔可有或无造影剂充填，可见内膜破口及剥离的内膜。结论螺旋CT对主动脉夹层的诊断准确率高，可以确诊，而且还可以判断夹层的范围、程度及分型，图像直观，直接显示主动脉夹层破裂的部位，能区分真假腔及腹腔干、双侧肾动脉、髂动脉等腹部血管是由真腔或假腔供血，图像盲观易懂。

Spiral CT Diagnosis of Aortic Dissection

Objective To improve the spiral CT awareness in the diagnosis of aortic dissection. Methods A retrospective analysis was made of 20 cases of aortic dissection,including clinical manifestations and imaging examination. All cases were scanned by using Siemens 16-slice spiral CT machine,with chest and abdomen plain and enhanced scanning according to lesion type and scope of the decision. Results All cases had chest pain for 1h to 5 years,with chest tightness and air tight in 3 cases,cardiac arrhythmia in 1 case,low back pain in 2 cases,abdominal pain in 1 case and 1 case associated with hoarseness and dyspnea （consider thickened esophageal nerve compression caused by aortic）. Imaging showed multiple aortic thickening and two visible true and false lumen,and false lumen might be filled with or without contrast agent,showing intimal tear and dissection of the intima. Conclusion Spiral CT diagnosis of aortic dissection has high accuracy,the cases can be confirmed, and also can determine the scope of dissection, extent and type.