孤立性腹主动脉夹层的MSCTA诊断

MSCTA Findings of Isolated Abdominal Aortic Dissection

目的:探讨多层螺旋CT血管造影(MSCTA)及其后处理技术对孤立性腹主动脉夹层(IAAD)的临床诊断和治疗价值。方法:回顾性分析34例具有典型CTA表现的IAAD患者资料,结合容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)后处理图像,分析IAAD的临床及影像特征。结果:34例中,I型(肾动脉上型)7例,Ⅱ型(肾动脉下型)27例,其中6例累及内脏血管。CTA清晰显示撕裂内膜34例,4例假腔内可见血栓形成。夹层长度(47.5±42.2)mm,夹层直径(26.7±10.5)mm,真腔直径(13.7±5.1)mm。1例行血管介入支架治疗,33例行保守治疗。其中7例经保守治疗后复查CTA,随访时间平均(17.0±20.1)个月,6例显示动脉夹层稳定。结论:MSCTA能清晰显示IAAD病变特征和累及范围,是评价治疗效果及追踪复查的有效方法。

Purpose: To investigate the value of multi-slice spiral computed tomographic angiography(MSCTA and post-processing technique in the diagnosis and treatment decision of isolated abdominal aortic dissection(IAAD).Methods: Thirty-four patients with IAAD proved by typical CTA features were retrospectively analyzed. Clinical features and CT images of IAAD were analyzed through CTA images with volume rendering(VR), multi-planar reconstruction(MPR), curved planar reformation(CPR) and maximum intensity projection(MIP). Results: There were 7 cases of type I(suprarenal IAAD), 27 type Ⅱ(infrarenal IAAD), visceral artery were involved in 6 cases.Intimal flaps were found in 34 patients, thrombus formation of false lumen were found in 4 patients. The length of IAAD was(47.5±42.2) mm, the diameter of IAAD was(26.7±10.5) mm, true lumen diameter was(13.7±5.1) mm.In 34 patients, 1 was undergone endovascular treatment and 33 were treated conservatively. During a follow-up of(17.0±20.1) months in 7 patients, 6 patents with IAAD were stable. Conclusion: MSCTA could evaluate morphologic features and show the extent of IAAD, and plays an important role in therapy evaluation and follow-up exam.