MSCT对主动脉壁内血肿与穿透性溃疡的应用价值

The value of multi-slice spiral CT in aortic intramura hematoma and penetrating ulcers

目的探讨多层螺旋CT(MSCT)诊断主动脉壁内血肿及穿透性溃疡的价值。方法 11例主动脉壁内血肿患者采用多层螺旋CT进行平扫及增强扫描并结合多模式重组如多平面重建(MPR)、曲面重建(CPR)及容积再现(VR)等方法显示壁内血肿及穿透溃疡,并参照Stanford分类法进行分型。结果 11例主动脉壁内血肿,1例为A型,10例B型(其中3例伴有穿透性溃疡)。主要CT表现:①全部病例均见主动脉壁呈半月形或环形增厚,CT平扫时呈高密度,增强后无强化。②内膜钙化向内移位6例。③并发心包、胸腔积液共9例。其中穿透性溃疡(Penetrating athero-sclerotic ul-cer)增强扫描表现为增厚的主动脉壁(斑块)内有造影剂充盈的龛影。在多平面重建、曲面重建成像技术中11例均清晰显示血肿部位、厚度、累及范围及有无并发症。结论多层螺旋CT并结合重组技术能提高诊断主动脉壁内血肿的准确性,具有重要的诊断及临床应用价值。

Objective To evaluate the diagnostic value of multi-slice spiral CT（MSCT） in aortic intramural hema-toma（AIH）.Methods MSCT plain and enhanced scans were performed and reconstructed imaging of MPR,CPR and VR in 11 patients with AIH.The emphasis was shown the penetrating ulcers and intramural hematoma and was classified according to the standard classification.Results Among 11cases with AIH,1 patients were type A,and10 patients were type B.The CT findings showed as follows： All cases developed with demilune or orbicular incrassation of the aortic wall.CT plain scanning showed high density,no aggrandizement after enhanced scanning.6 cases showed inner layer shift as well as calcification.9 cases complicated with dropsy in pericardiumand and thorax.Penetrating ulcers showed niche with contrast media in the aortic wall after enhanced scanning.On MPR and CPR images clearly displayed sites,thickness,extension and complications of haematoma in 14 cases.Conclusion MSCT combined with reconstruction techniques of MSCT plays an important role in diagnosis.