不典型主动脉夹层螺旋CT诊断

目的 回顾性分析不典型主动脉夹层的CT改变,探讨螺旋CT诊断不典型主动脉夹层的价值。方法 分析21例不典型主动脉夹层,并参照Stanford分类法进行分型。结果 21例不典型主动脉夹层,13例为A型,8例B型。CT表现：（1）主动脉壁呈半月形或环形增厚,CT平扫时呈高密度,CT值约50～80Hu,增强后无强化,与强化主动脉管腔对比反呈低密度。治疗后复查,壁内血肿由于吸收及演变为慢性血肿,厚度及长度减小,CT平扫时密度较前降低而呈低密度。（2）内膜钙化向内移位7例。（3）主动脉管腔狭窄、变形16例。（4）全部病例主动脉壁均有不同程度的动脉粥样硬化改变：主动脉壁不规则增厚、钙化。（5）并发心包、纵隔及胸腔积液和积血共19例。结论 螺旋CT清楚显示血肿部位、厚度、累及范围及有无并发症,为临床诊治及预后提供了重要的信息,是一种安全、有效、无创的诊断方法 。

Spiral CT diagnosis of atypical aortic dissection

Objective To evaluate the clinical application of spiral CT in diagnosis of atypical aortic dissection(ASL). Methods The CT features of 21 cases with atypical aortic dissection were analyzed retrospectively. All cases were classified into tow group according to Stanford methods. A:13 cases ; B: 8 cases. Results The spiral CT features of atypical dissection were as follows: (1) continuous crescentic or circle areas along the wall of aortic with CT value of 50-80HU, after enhancement, these areas were still low density contrast to the enhanced aortic lemin. Intramural hematoma changed into chronic hematoma and decreased in its length and thickness. (2) displacement of intimal calcifica- tion(7 cases).(3) aorta sclerosis and malformation (16 cases) (4) atheroscletotic plaque and calcification on the aortic wall in all cases. (5) 19 cases complicated with dropsy and haematocele in the pericardium, mediastinum and thorax. In clinical follow-up, all cases dergone internal medicaltherapy, symptoms and signs stabilized and disappeared. In afterwards clinic follow-up, 2 cases died in nature. Conclusions Spiral CT could clearly display sites, thickness, extension, and d complications of haematoma, played an important role in diagnosis of ASL.