多层螺旋CT血管成像在主动脉壁间血肿的临床应用

目的探讨主动脉壁间血肿（IMH）MSCT表现和诊断价值。方法10例经多层螺旋CT诊断及临床证实的IMH，男6例，女4例。使用16层螺旋CT检查，应用多平面重建、最大密度投影和容积成像等后处理方法显示壁间血肿及穿透性溃疡。结果10例IMH中，A型2例，B型8例，其中2例局限于胸主动脉，6例累及胸腹主动脉（止于肾动脉上方2例，髂总动脉分叉上方2例，2例累及双侧髂总动脉）。MSCT表现为主动脉腔内新月形或环形充盈缺损，内壁较光整，钙化内膜片内移及局灶性尖角样穿透溃疡形成，主动脉腔内无明确内膜片显示。结论多层螺旋CT能为主动脉壁间血肿的诊断、鉴别诊断和治疗提供准确的信息。

Clinical application of multi-slice spiral CT angiography in the diagnosis of aortic intramural hematoma

Objective To evaluale the signs of aortic intramural hematoma（IMH）with 16-slice spiral CT angiography（MSCTA）and their diagnostic significance.Methods Ten patients（6 men and 4 women）with clinically proved IMH underwent CT examinations with different post- processing techniques such as multiplanar reformation （MPR）,maximum intensity projection （MIP）and volume rendering （VR）in visualizing IMHs and penetrating ulcers.Results MSCTA demonstrated there were 2 type A and 8 type B in 10 patients with IMH in whom 2 localized in thoracic aorta and 6 involved into thoracic-abdominal aorta which comprised 2 reaching to upper facet of renal arteries,2 reaching to upper facet of bilateral common iliac artery branch off and 2 involving into bilateral common iliac arteries.MSCTA showed the crescent-or circular filling defects in aortic cavities,smoth-regular inner walls,internal shift of calcified intimal pieces and the formation of local sharp-angled penetrating ulcers but did not show definite intimal piece in aortic cavities.Conclusion MSCTA can provide the accurate informations for the diagnosis,differential diagnosis and treatment of aortic intramural hematoma.