64排螺旋CT用于体部动脉性病变的诊断

Clinical Application of 64 Multi-detector Row CT in the Diagnosis of Body Arterial Diseases

目的：评价64排螺旋CT血管造影（64-MDCTA）及重建技术在体部动脉（除冠状动脉外）性病变诊断中的临床应用价值。方法：102例患者（包括颈、椎动脉19例、肺动脉5例、胸腹主动脉及其分支49例,双下肢动脉29例）行64-MDCTA检查,采用准直0.625mm,层厚0.625mm,间隔0.5~0.625mm。应用多平面重建（multiple planar reconstruction,MPR）,曲面重建（curved planar reconstruction,CPR）,最大密度投影（maxi mumintensity projection,MIP）,容积显示技术（volume renderingtechnique,VRT）以及血管分析（vessel analysis,VA）软件进行图像重建及分析。结果：102例体部动脉病变中,CTA显示：颈动脉钙化斑块伴狭窄10例,颈动脉体瘤3例,颈总动脉假性动脉瘤1例,颈动脉鞘内神经源性肿瘤伴血管推移1例,椎动脉狭窄1例,椎动脉瘤1例,正常颈动脉2例,肺动脉栓塞4例,正常肺动脉1例,马凡氏综合征2例,大血管转位1例,胸、腹主动脉瘤15例,假性动脉瘤3例,夹层动脉瘤11例,夹层动脉瘤术后随访8例,脾动脉瘤1例,肾动脉斑块、狭窄2例,右肾动脉狭窄支架术后随访1例,腹主动脉瘤术后随访2例,椎体骨质增生压迫腹主动脉1例,正常主动脉1例,正常腋动脉1例,髂动脉瘤3例,股髂动脉血栓、闭塞4例,双下肢动脉硬化性闭塞症14例,下肢血管动静脉瘘3例,下肢动脉术后随访4例,正常双下肢动脉1例。以上几种重建技术均能显示病变发生部位、大小、形态、范围,对病变可从不同角度观察,VRT能三维立体显示病变,MPR、CPR、MIP均能显示血栓、钙化,MPR、CPR、VA能显示动脉管腔及支架腔内情况。102例中63例经手术或DSA证实。结论：64-MDCT能够全面清晰显示体部动脉病变,为患者提供快速及有效、可靠的诊断手段,对临床诊断、治疗具有重要指导意义。

Objective：To evaluate the value of 64 multi detector row CT angiography（64-MDCTA） and it＇s reconstruction techniques in the diagnosis of body arterial diseases. Methods： Using 0. 625 mm collimation, 0. 625 mm slice thickness and 0.5- 0. 625 mm interval, 64 MDCTA was performed in 102 patients, whose target arteries included carotid and vertebral artery（n = 19）, pulmonary artery（n = 5） ,thoracic and/or abdominal artery and main branches（n = 49）, both lower extremity artery （n = 29）. Reconstruction methods were multiple planar reconstruction （MPR）, curved planar reconstruct ion（CPR）, maximum intensity projection（MIP）, volume rendering technique（VRT） and vessel analysis（VA）. Results： 64-MDCTA demonstrated carotid and vertebral artery calcification with stenosis（n = 10）, carotid body tumor （n = 3）, false aneurysm of common carotid artery（n = 1 ）, neurogenic tumor in carotid sheath（n = 1 ）, vertebral artery stenosis（n = 1 ）, aneurysm of vertebral artery（n = 1 ）, normal carotid artery （n = 2）, pulmonary embolism（n = 4）, normal pulmonary artery （n = 1 ） ,Mar fan＇s syndrome（n = 2）, great vessels transposition（n = 1 ）, aneurysm of thoracic and abdominal artery（n = 15）, false aneurysm of thoracic and abdominal artery（n = 3）, dissecting aneurysm of thoracic and abdominal artery （n = 11 ）, post-operation of dissecting aneurysm （n = 8）, splenic artery aneurysm（n = 1 ）, renal artery plaque and stenosis （ n = 2 ）, post-operation of right renal artery stenosis （ n = 1 ）, post-operation of aneurysm of aorta （n = 2）, abdominal aorta was oppressed by hyperostosis of lumbar vertebrae（n = 1 ）, normal arteriae aorta （n = 1 ）, normal axillary artery （n = 1 ）, aneurysm of lilac artery（n= 3）, femoral and lilac artery block with thrombus（n = 4）, both low extremities ASO（ n = 14）, arteriovenous fistula of low extremities vessels （n = 3）, post-operation of low extremity artery（n = 4）, normal low extremities artery（n = 1 ）. These 5 kinds of reconstruction techniques showed the location, size, shape and extent of the lesions and displayed the lesions in any directions. VRT could display three-dimensionally the lesions. MPR,CPR and MIP could show the thrombus and the calcification of lesions. MPR,CPR and VA could show the lumen of the artery and the intravascular stent. 63 patients were proved by operation or DSA. Conclusion：64 MDCTA can display the various artery lesions. It provides quick and reliable diagnostic information for patients and has clinical importance for treatment.