主动脉壁内血肿的64层螺旋CT诊断

Multi-slice Spiral CT Manifestations of Intramural Hematoma of Aorta

目的:探讨64层螺旋CT诊断主动脉壁内血肿(AIH)的价值。方法:对25例主诉急性胸背痛患者进行64层螺旋CT检查(连续容积扫描),均经临床及影像学检查诊断为主动脉壁内血肿。结果:25例AIH患者按Stanford分型,A型2例,B型23例。MSCT征象:25例均见主动脉壁呈新月形或环形增厚,厚度≥5mm,无内膜破裂形成的双腔主动脉征象。平扫呈高密度11例,高密度为主的混杂密度8例,等密度6例。21例见钙化内移征象,5例可见穿透性溃疡征,动脉粥样硬化性改变18例,内膜渗透3例,血肿分层征象2例。并发心包积液4例,胸腔积液16例,主动脉夹层3例,主动脉瘤2例。结论:MSCT能为主动脉壁内血肿的诊断和治疗提供重要信息,且便于治疗后随访观察,可以作为AIH的首选诊断及随访检查方法。

Objective：To assess the value of 64-slice spiral CT （MSCT） in the diagnosis of aortic intramural hematoma （AIH）.Methods：Twenty-five patients who complained of acute chest and back pain underwent 64-slice spiral CT using continuous volume scanning.AIH was diagnosed according to the results of clinical and imaging examinations.Results：Of the 25 patients with AIH,according to the Stanford classification,there were two patients with Stanford type A,the rest of them were type B （23 patients）.The MSCT features included crescent or circular thickening （≥5mm） of the aortic wall in all 25 patients with no double lumen sign resulting from intimal rupture.High attenuation of the thickened aortic wall could be revealed in 11 patients,heterogeneous attenuation mainly with high density in 8 patients and iso-attenuation in 6 patients.Calcified plaque （21 cases）,penetrating ulcer （5 cases）,atherosclerosis （18 cases）,leakage （3 cases） and laminae formation of hematoma （2 cases） were observed.The features of complication included pericardial effusion （4 cases）,pleural effusion （16 cases）,aortic dissection （3 cases） and aortic aneurysm （2 cases）.Conclusion：Important information for the diagnosis and treatment of AIH could be provided by MSCT,which is also useful for post-treatment follow-up.MSCT can be used as the first choice modality for the diagnosis and follow-up of AIH.