16层螺旋CT血管成像在主动脉夹层中的应用

The value of 16-slice spiral CT angiography in diagnosis of aortic dissection

目的评价16层螺旋CT血管成像(MSCTA)在主动脉夹层中的诊断价值。方法对21例主动脉夹层患者行增强扫描,将获得的容积数据进行容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)和仿真内窥镜(VE)后处理。结果21例主动脉夹层均能明确显示真假腔和内膜片,以轴位像、MPR、VR显示最佳,DeBakeyⅠ型2例,Ⅱ型1例,ⅢA型2例,ⅢB型16例;21例均见到明确的初始破裂口,显示率为100%,以轴位像、MPR像上显示为佳,结合VR可立体显示破裂口形态、大小及与主动脉分支的关系;1例Ⅱ型夹层,无名动脉受累,1例ⅢB型夹层合并右位主动脉弓伴迷走左锁骨下动脉的右锁骨下动脉(该患者右锁骨下动脉、右颈总动脉分别起源于主动脉弓)受累,20例Ⅰ、Ⅲ型中,腹腔动脉受累4例,肠系膜上动脉受累5例,肾动脉受累4例;21例夹层中,16例可显示假腔内多少不等的血栓充填。结论16层螺旋CT血管成像(MSC-TA)是诊断主动脉夹层的无创、快速、准确检查方法。

Objective To assess the value of 16-slice Spiral CT angiography（MSCTA） in diagnosis of aortic dissection. Methods All 21 patients with aortic dissection were performed by MSCTA and the source images were post-processed using volume rendering （VR） ,multiplannar reformation（MPR）,maximum intensity projection（MIP） and virtual endoscopy（VE）. Results The double lumen and intimal flap could be shown in 21 cases using axial,MPR and VR images. There were 2 eases of Del3akey type Ⅰ dissection （involving the entire aorta）, 1 type Ⅱdissection （only involving the ascending aorta）,2 type ⅢA dissections （only involving the thoracic descending aorta）, 16 type ⅢB dissections （involving the thoracic and abdominal descending aorta）, respectively. Initial entry sites were defined in all cases in axial and MPR images;the shape,size and the relationship between the aortic orifice and the initial entry sites were clearly depicted three-dimensionally combining axial, MPR and VR images. The orifice of anonymous artery was involved in 1 type Ⅱdissection;the orifice of right subclavian artery involved in 1 type ⅢB dissection with an aberrant left subclavian artery arising distal to the right aortic arch. In 20 cases of type Ⅰ and Ⅲ dissections, there were 4 cases involving in the celiac arterial orifice,5 in the superior mesenteric arterial orifice and 4 in the kidney arterial orifice,respectively. Some thrombi in the false lumen was found in 16 cases. Conclusion The 16-slice spiral computed tomography angiography is a non-invasive, fast and accurate method in diagnosis of aortic dissection.