主动脉壁内血肿的影像学诊断及鉴别诊断

Imaging diagnosis and differential diagnosis of aortic intramural hematoma

目的:探讨主动脉壁内血肿的影像学诊断和鉴别诊断。方法:回顾性分析16例经临床及CT和MRI诊断的主动脉壁内血肿及5例可疑壁内血肿患者的病例资料。12例因胸痛或腹痛入院、经CT或MRI扫描时发现,4例为外伤或内科疾病行胸部或腹部检查时意外发现;另外搜集18例主动脉夹层及11例主动脉瘤患者的影像学资料。结果:16例主动脉壁内血肿,表现为主动脉壁环形增厚7例,新月形增厚5例,环形和新月形增厚同时存在或不规则增厚4例,腔内无内膜片及真假两腔形成,增厚的血管壁内无对比剂进入。5例可疑主动脉壁内血肿表现为管壁轻度环形增厚。18例主动脉夹层均可见真假两腔及内膜片,其中14例其真假腔在横轴面图像上表现为"D"字形或反"D"字形,真假两腔内均有对比剂进入;11例主动脉瘤表现为血管瘤样扩张或梭形扩张,无真假两腔和内膜片,其中8例可见附壁血栓。结论:CT平扫及增强扫描结合图像后处理技术及MRI多方位成像能够诊断较为典型的主动脉壁内血肿,并与主动脉其它常见疾病相鉴别。

Objective：To explore the imaging diagnosis and differential diagnosis of aortic intramural hematoma.Methods：A retrospective analysis from July 2002 to April 2010 was made on 16 cases of aortic intramural hematoma,which were diagnosed by clinical data and CT or MR scan,and other 5 cases of suspected intramural hematoma were collected.From the 16 cases,12 cases were admitted to hospital and were found by CT scan or MR scan due to chest pain or abdominal pain,4 cases were found accidentally through chest or abdominal examination because of trauma or medical illness.In addition,18 cases of typical aortic dissection and 11 cases of aneurysm were collected.Results：Among the 16 cases of aortic intramural hematoma,7 cases showed circular aortic wall thickening,5 cases showed crescent thickening,4 cases showed both circular and crescent thickening or irrigular thickening.There was no intimal flap,no true and false lumen formation,and no contrast agent entered the thickend blood vessel wall.5 cases of suspected intramural hematoma showed slight circular aortic wall thickening.18 cases of aortic dissection showed true and false lumen and intimal flap formation,and 14 cases of true and false lumen showed D-shape or reverse D-shaped on transverse section,contrast agent entered the two lumens.11 cases of aneurysm showed tumor-like expansion or fusiform expansion,no true and false lumen and intimal flap formation,8 cases among the 11 cases showed mural thrombus.Conclusion：A typical aortic intramural hematoma can be diagnosed by multi-directonal magnetic resonance imaging or CT scan with post-processing techniques,and it is easy to distinguish it from other common aortic diseases.DSA、CE-MRI and CINE-MRI can be used for reference.