双源CT血管成像技术在AIMH诊断及EVE术后随访中的临床应用价值

Clinical Value of Dual-source CT Angiography in the Diagnosis of Postoperative Aortic Intramural Hematoma in Patients with Endovascular Stent-graft Exclusion Surgery

目的探讨双源CT血管成像技术（dual—source CT angiography，DSCTA）在主动脉壁内血肿（aortic intramural hematoma，AIMH）诊断及腔内支架隔绝（endovascular stent-graft exclusion，EVE）术后随访中的临床应用价值。方法2008年10月至2013年5月间，36例患者经DSCTA检查诊断为AIMH，其中12例StanfordB型患者EVE术后行DSCTA随访观察。在工作站上完成患者的图像重建及分析工作，重建技术包括多平面重组（MPR）、最大密度投影（MIP）及容积再现技术（VRT）等。壁内血肿患者重点观察血肿CT表现、血肿累及范围并分型、是否并发主动脉壁溃疡等，EVE治疗患者则重点观察血肿转归及并发症情况。结果36例AIMH包括StanfordA型11例、StanfordB型25例。所有患者血肿区域均未见撕裂内膜片显示及对比剂进入血肿内。血肿部位主动脉最大直径3．8～5．4cm（平均4．3cm），血肿最厚径0．5～1．3cm（平均0．9cm），血肿最厚层面主动脉腔最小直径／最大直径比值为0．74～0．98（平均0．85）。3例StanfordA型、8例StanfordB型可见到一个或多个溃疡形成，3例StanfordB型患者并发腹主动脉远端内膜撕裂。12例EVE治疗患者术后血肿均有不同程度缩小，4例血肿基本吸收，3例支架覆盖区溃疡消失。9例患者支架形态正常，3例支架稍变形。所有患者未见支架内漏，大分支血管通畅。结论DSCTA检查具有操作简便、准确性高且无创等优点，可以作为AIMH诊断及EVE术后随访重要的影像学方法。

Objective To determine the clinical value of dual-source CT angiography （DSCTA） in the diagnosis of postoperative aortic intramural hematoma （AIMH） in patients with endovascular stent-graft exclusion （EVE） surgery. Methods Between Oct 2008 and May 2013, thirty-six patients were diagnosed with AIMH by DSCTA, and 12 of these patients with type B underwent EVE. The 12 patients were followed up with DSCTA, which included imaging reconstruction （multi-plane reconstruction, MPR）, maximum intensity projection （MIP） and volume rendering technique （VRT）. The extent and type of AIMH, aortic ulcers and the outcomes and complications of AIMH were observed. Results The 36 cases of AIMH included 11 Stanford type A and 25 type B. No tearing intimal flap or contrast materials within the hematoma were observed. The maximum aortic diameter of the hematoma areas varied from 3.8 to 5. 4 cm （average 4. 3 cm） and the maximum thickness of the hematoma ranged from 0.5 cm to 1.3 cm （average 0.9 cm）. The ratio between the minimum and the maximum diameter of the aortic lumen in the hematoma areas ranged from 0. 74 to 0. 98 （average 0. 85）. Aortic ulcers were revealed in 3 patients with type A AIMH and 8 patients with type B AIMH. Intimal tearing of distal abdominal aorta was found in 3 patients with type B AIMH. In the 12 patients underwent EVE surgery, hematoma shrank in all cases with 4 cases almost resolving and aortic ulcers in the area of stent-graft exclusion disappeared in 3 cases. The form of stent- graft appeared normal in 9 cases and slightly abnormal in 3 cases. Fluent main branches of aortic arch and none existence of stent endoleaking were observed. Conclusion DSCTA with handy, effective and non-invasive advantages is one of the important imaging methods in the diagnosis of AIMH in patients with EVE surgery.