电子束CT诊断粥样硬化性主动脉溃疡的价值

The diagnosis of atherosclerotic aortic ulcer by electron beam CT

目的利用电子束 CT(EBCT)探讨粥样硬化性主动脉溃疡的影像学特点及其与壁内血肿、夹层和动脉瘤的关系。方法回顾分析68例经 EBCT 诊断的粥样硬化性主动脉溃疡,采用EBCT 扫描机,连续容积增强扫描,层厚6.0 mm,床进3.5 mm或层厚3.0 mm,床进3.0 mm,扫描时间为0.1 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。结果 68例患者中并发壁内血肿36例(52.94%),均伴有急性主动脉综合征;并发动脉瘤15例(22.59%);并发夹层3例(4.41%)。溃疡的形态表现:乳头状17例,指状2例,蘑菇状21例,半圆形10例;多发不规则形18例。22例为稳定性溃疡,46例有活动性溃疡且常伴发急性主动脉综合征(P<0.01)。不同形态的溃疡与不同特性的溃疡(稳定性和活动性)差异有统计学意义(P<0.01)。68例溃疡灶的分布:升主动脉3例,主动脉弓34例,降主动脉18例,腹主动脉13例,主动脉弓较其他部位更易形成溃疡(P<0.01)。结论 EBCT 能对主动脉病变精确定位,对粥样硬化性主动脉溃疡的形态、性质等细节特点作出精确判断,对临床有明确的指导意义。

Objective To evaluate the clinical value of dectron beam computed tomography （EBCT） in the diagnosis of atherusclerotic aortic ulcer. Methods Sixty-eight consecutive patients （55 men and 13 women, aged 40-85 years, mean 65. 12 ± 9. 55 years） with atherosclerotic aortic ulcer, who underwent EBCT scans from December 2001 to December 2004, were studied retrospectively. Contrastenhanced continuous volume scanning （CVS） was performed by Imatron C-150XP EBCT scanner with 6 mm or 3 mm slice thickness and 100 milliseconds acquisition time. The scan was started 18-30 s after the injection of 80-100 ml contrast medium at the rate of 3.5-4. 5 ml/s. Results In sixty-eight patients with atherusclerotic aortic ulcer, 50 patients had acute aortic syndromes,36 had intramural hematomas, 15 had atherusclerotic aortic anenrysms, 3 had aortic dissections. 46 patients with progresive ulcer usually had acute aortic syndrome while 22 patients with stable ulcer didn＇t（P 〈0. 01 ）. Atherosclerotic aortic ulcer was seen more frequently in the aorta arch than other portions of the aorta（ P 〈 0. 01 ）. Conclusion EBCT is a very useful tool for the detection and follow-up of atherusclerotic aortic ulcer.