主动脉壁内血肿的影像学分析

The Analysis of Imageology 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,为临床诊断工作提供可靠的参考依据。方法:选择2013年1月-2014年12月笔者所在医院经临床检查证实为主动脉壁内血肿的46例患者,分析其胸部X线平片、CT及MRI特点,对比X线、CT以及MRI诊断主动脉壁内血肿的准确率。结果:46例主动脉壁内血肿,表现为主动脉壁环形增厚17例,新月形增厚15例,环形和新月形增厚同时存在或不规则增厚14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。胸部X线平片、增强CT、MRI均可见阳性征象,CT、MRI直接观察到病变程度及累及的范围。X线、MRI以及CT诊断主动脉壁内血肿的准确率分别为60.0%、71.7%、100%。结论:CT扫描及MRI成像能够诊断较为典型的主动脉壁内血肿,并与主动脉其他常见疾病相鉴别,是主动脉壁内血肿诊断的有效手段,综合分析临床表现利于早期确诊,加强血压控制利于病变稳定。

Objective： To explore the imaging diagnosis and differential diagnosis of aortic intramural hematoma.Method： 46 cases of aortic intramural hematoma which were confirmed by clinical examination from January 2013 to December 2014 were selected.Its chest X-ray plain film, CT and MRI eharacteristics were analyzed, and their accuracy were compared.Result： Among the 46 cases of aortic intramural hematoma, 17 cases showed circular aortic wall thickening, 15 cases showed crescent thickening, 14 cases showed both circular and creseent thickening or irregular thickening.There was no intima｜ flap, no true and false lumen formation, and no contrast agent entered the thickening blood vessel wall.Positive imaging signs could be demonstrated on plain chest radiograph, enhanced CT, MRI.CT and MRI could directly display the degree and extent of the lesion.The accuracy in diagnosis ofCT, MRI and X-ray reached 100%, 71.7%, 60.0% respectively.Conclusion： A typical aortic intramural hematoma can be diagnosed by MRI or CT, and it is easy to distingnish it from other common aortic diseases. CT and MRI are effective for early diagnosis of AIH.h is favorable to early diagnosis by comprehensive analysis of clinical manifestations and strengthen blood pressure lowing.