Stanford B型主动脉壁内血肿伴有溃疡样病变CT随访研究

Prognosis of ulcerlike projections accompanying stanford B acute aortic intramural hematoma

目的：探讨Stanford B型急性主动脉壁内血肿（IMH）伴有溃疡样病变（ULP）的多层螺旋CT（MDCT）表现及其转归。方法：回顾性分析16例Stanford B型急性IMH伴有ULP患者的64层螺旋CT增强扫描影像学资料,观察ULP的位置、大小及随访结果。16例患者中,男性11例,女性5例,年龄49-86岁（平均68.1岁）,16例患者均为保守治疗,随访时间3-12个月（平均6.1个月）。结果：16例ULP均为单发,3例ULP位于主动脉弓凹面,9例ULP位于胸主动脉,4例ULP位于腹主动脉,深度为2-9.5mm（平均3.9mm）,所有的ULP边缘光整,无钙化,8例（50%）ULP保持稳定,4例（25%）减小或吸收,3例（18.8%）增大,1例（6.2%）进展为主动脉瘤。结论：Stanford B型IMH合并ULP较为常见,出现ULP并非都为预后不良征象,该类患者需要影像学的密切随访。

Objective：The purpose of this study was to investigate the clinical outcome of ulcerlike projections（ ULP） accompanying Stanford B acute aortic intramural hematoma（ IMH）. Methods： We retrospectively analyzed 16 patients（ 11 male,5 female,49-86 years old,average 68. 1） with Stanford B acute IMH accompanied by ULP in whom 64-row MDCT was performed,the location,size and follow-up results of ULP was recorded. Results： Sixteen cases all had single ULP lesion. 3 lesions were located at the concavity of aortic arch,9 lesions were located at thoracic aorta,and 4 lesions were located at abdominal aorta. The depth of the lesions was between 2 to 9. 5 mm（ average 3. 9 mm）. 8（ 50%） lesions showed stable,4（ 25%） lesions showed decrease or regression,3（ 18. 8%） lesions showed enlargement,and 1（ 6. 2%） lesion progressed to aortic aneurysm. Conclusion： Stanford B acute IMH accompanied by ULP was frequently encountered at multidetector CT. Not all of ULPs were associated with a poor prognosis,but patients with ULP should be carefully followed up with serial CT scans.