穿透性粥样硬化性主动脉溃疡的多层螺旋CT血管成像特点

Multi-slice CT angiography features of penetrating atherosclerotic ulcer

目的探讨主动脉穿透性粥样硬化性溃疡(PAU)的多层螺旋CT血管成像(MSCTA)特点。方法回顾性分析经MSCTA确诊的46例PAU患者的临床及影像学资料,观察溃疡的部位、数目、形态、分布及分型,并记录随访时溃疡的动态改变情况。结果 46例患者均可见主动脉壁内龛影,形状为蘑菇形、乳头形、不规则形、半圆形,以前三者居多;病灶多见于腹主动脉及胸腹主动脉,以多发溃疡病灶为主,以Stanford B型常见。有32例患者并发壁间血肿。短、中期随访中,PAU增大患者12例,病灶形态以蘑菇形、半圆形、乳头形为主;PAU缩小4例,稳定30例,形态以不规则形溃疡为主。长期随访中,6例患者PAU保持稳定并趋于好转。结论 PAU的典型位置是胸降主动脉或腹主动脉,常伴发壁间血肿;壁内龛影是MSCTA特征表现,其形态可能与临床转归密切相关。

Objective To explore the multi-slice CT angiography（ MSCTA） features of penetrating atherosclerotic ulcer（ PAU）.Methods The clinical and radiological data of 46 patients with PAU identified by MSCTA were retrospectively analyzed. The site,quantity,morphology,distribution and type of the ulcers were observed. The dynamic changes of the ulcers were recorded during the follow-up. Results Intramural niche sign of the aorta was observed in all of the 46 patients. The shapes of lesions included mushrooms shape,nipple shape,irregular shape and semi-circular shape,and the first three shapes were in the majority. Lesions were mainly found in the aorta abdominalis and thoracoabdominal aorta. Multiple ulcers and ulcers of type Stanford B were more commonly observed. Complication with intramural hematoma occurred in 32 patients. During the short-and medium-term follow-up,enlargement of PAU mainly with mushroom,nipple and semi-circular types was found in 12 patients; reduced PAU mainly with irregular type in 4 patients and stable PAU mainly with irregular type in 30 cases. In the 6 patients receiving the long-term follow-up,PAU was stable and tended to be improved. Conclusion The typical locations of PAU are thoracoabdominal aorta and aorta abdominalis. Intramural hematoma is defined as common complication. Intramural niche sign of the aorta is the typical manifestation of MSCTA,and its morphology might closely relate to the clinical outcomes.