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。

The Diagnosis of Multi-Slice Spiral CT Angiography in Acute Intramural Hematoma Associated with Penetrating Aortic Ulcer

Objective To evaluate the value of multi slice spiral CT angiography in the diagnosis of acute Intramural hematoma(IMH) associated with penetrating aortic ulcer.Methods Twenty cases of IMH associated with PAU were examined with MSCT.Two dimensional and three dimensional imags were analyzed.Results Twenty cases were divided into Stanford A type(n=5) and Stanford B type(n=15).True and flase lumen,intimal flap were not be shown,and IMH were associated with penetrating aortic ulcer in all cases.crescent or circular thickening of aorta wall were found in IMH,as well as displacement of intimal calcification(12 cases),pleural effusion(8 cases),pericardial effusion(4 cases).There were 28 lesions of penetrating ulcer were found in 20 patients,in which u1cer like aortic projections were observed.There were 22 lesions of PAU in 14 patients(79%),and 6 lesions of ULP in 6 patients(21%).Conclusion Multi slice Spiral CT Angiography is an effective method for the diagnosis of acute Intramural hematoma(IMH) associated with penetrating aortic ulcer by providing valuable information for the diagnosis and treatment.