不典型主动脉夹层的多层螺旋CT诊断价值

Value of multi-stlice spiral CT in diagnosing atypical aortic dissection

目的:回顾性分析不典型主动脉夹层(atypical aortic dissection,AAD)的CT表现,探讨螺旋CT诊断AAD的价值。方法:25例AAD患者,全部行平扫及增强扫描,并结合多平面重组、曲面重组等方法显示AAD及穿透溃疡,根据Stan-ford分类法分型。结果:25例AAD,A型7例,B型18例。主要CT表现:主动脉壁呈新月型或环形增厚,无内膜破裂形成的双腔主动脉征象,增强扫描假腔无强化。内膜钙化向内移位7例,穿透性溃疡征3例。并发心包、纵隔及胸腔积液和积血共10例。经内科保守治疗后,6例完全吸收,3例部分不典型吸收,2例无明显变化。结论:螺旋CT清楚显示夹层的部位、范围及并发症,可作为主动脉夹层的首选检查及随访方法。

Objeetive： The CT findings of atypical aortic dissection（AAD） was analyzed retrospectively to analyse the diagnostic value of multi slice spiral CT on atypical aortic dissection. Methods： MSCT plain and enhanced scans were performed and reconstructed images of MPR and CPR in 25 patients with AAD were obtained. The penetrating ulcers and intramural hematoma were classified according to Stanford classification. Results： Among 25 cases with AAD, 7 cases were type A,and 18 cases were type B. The spiral CT features of AAD were as follows： all cases developed with semi-lunar or circular increase of the aortic wall, without intimal flap tearing as double-lumen. After enhancement, the false lumen was still low density, 7 cases showed inner layer shift as well as calcification; 3 cases showed the penetrating ulcers; 10 cases with complicated dropsy and hematocele in the pericardium,mediastinum and thorax; 6 cases were observed in complete regression, 3 cases were observed incomplete regression and 2 cases were observed without changing after conservative treatment. Conclusion： Spiral CT can clearly display sites,thickness,extension and complications of aortic dissection. MSCT can be used as the first means in the diagnosis and follow-up of AAD.