计算机体层摄影术观察粥样硬化性主动脉溃疡的动态变化

Atherosclerotic aortic ulcers monitoring by electron beam CT or multi-slice CT

目的利用计算机体层摄影术(CT)研究粥样硬化性主动脉溃疡的动态变化过程,为临床治疗和预防提供有意义的依据。方法回顾分析2001年12月至2006年1月35例患者,经临床及CT检查诊断有粥样硬化性主动脉溃疡病变,其中男31例,女4例,年龄40-79(56.2±10.8)岁,随访时间7-730(平均135)天,全部患者经电子束CT(EBCT)或多排CT检查≥2次。采用Imatron C-150XP型EBCT扫描机,连续容积增强扫描,层厚6 mm/床进3.5mm或层厚3 mm/床进3 mm,扫描时间为0.1 s;或美国通用电器公司Lightspeed-16扫描机进行连续容积增强扫描,层厚3.75 mm/床进1 mm,扫描时间为0.6 s。扫描范围自主动脉弓上水平至左、右髂动脉分叉处,共120-140层。测量溃疡的深度、口径及范围。结果35例粥样硬化性主动脉溃疡患者,均因急性主动脉综合征就诊,采用CT检查明确诊断。35例患者CT诊断31例合并壁内血肿,采用保守治疗;1例弓部大溃疡保守治疗;2例行血管内膜支架隔离术治疗;1例合并主动脉弓部瘤,外科手术治疗。31例溃疡伴有壁内血肿的患者行保守治疗,CT随诊,与首次CT检查结果比较,3个月、6个月时,溃疡口径、深度、长度随时间延长分别有加大、加深、延长的趋势(均P<0.05);主动脉壁内血肿的厚度有明显吸收[首次:(11.96±4.16) mm,3个月:(7.69±4.24) mm,6个月:(3.06±1.67) mm,均P<0.05]。结论CT对粥样硬化性主动脉溃疡患者定期随访有重要的指导意义,可根据病变的特点提供最佳治疗方案。

Objective To evaluate the evolution of medically treated atherosclerotic aortic ulcers by computed tomography （CT）. Methods Thirty-five patients （ 31 men and 4 women, aged from 40 to 79 years, mean 56. 2 ± 10. 8 years） with known aortic ulcers were monitored by CT （follow up time 7-730 days, mean 135 days）, 80-100 ml contrast media （Ultravist 300 or 320, or Ominpaque 300 or 320 mg/ml） was injected with a rate of 3. 5-4. 5 ml/s. The scan delayed time was 18-30 s. Ulcers dimensions were measured according to maximum depth, maximum length and maximum width. Results Thirty-one patients with intramural hematomas and 1 patient with atherosclerotic aortic arch aneurysm without intramural hematoma were medically treated and another 3 patients were surgically treated. Intramural hematoma regression was monitored in 31 medically treated patients with intramural hematomas. CT was repeated at 2 weeks, 3 and 6 months. Intramural hematoma resolved gradually during follow up [ thickness ： （ 7. 69 ± 4. 24） mm at 3 months, （3. 06 ± 1.67） mm at 6 months, P 〈 0. 05 vs. 1 st CT： （ 11.96 ± 4. 16） mm while ulcer maximum depth （ 11.17 ± 6. 03 ）mm at 3 months, （ 11.35 ± 5. 59） mm at 6 months ,P 〈 0. 05 vs. 1 st CT： （7. 36 ± 6.61） ram, maximum width （14.40±6.35） mm at 3 months, （18.55±10.94） mm at 6 months, P〈 0.05 vs. 1 st CT： （7.15±6. 39） mm, maximum length （ 17.12 ± 7. 15 ）mm at 3 months, （ 18. 13 ± 10. 89 ） mm at 6 months, P 〈 0. 05 vs. 1st CT： （ 11.64 ± 10. 06） mm increased progressively during follow-up]. Conclusion CT was a useful tool for defecting atherosclerotic aortic ulcers and monitoring therapeutic effects.