Computed tomography angiography-negative aortic dissection in a patient using Phencyclidine

Although the average age of diagnosis for aorticdissection is 63,[1] this case demonstrates the need toconsider AD in younger patients, particularly in thepresence of risk factors or in the absence of anotherreasonable diagnosis. This case suggests PCP use as aprecipitant for hypertension and sympathomimetic stresson the aorta. Despite high sensitivity, false negativeCTA imaging for AD can occur. If pretest probabilityremains high, further imaging must be obtained. Duringresuscitation in the ED, focused point-of-care ultrasoundcan also assist with medical decision making.

The Application of Computed Tomography Angiography in Aortic Dissection

Aortic dissection (AD) is a life-threatening clinical emergency requiring rapid diagnosis and effective intervention to improve patient survival and prognosis. Computed tomography angiography (CTA) can be used to diagnose AD accurately and quickly, making it the first choice for diagnosing AD in an emergency. This article reviews the application of CTA in the diagnosis and treatment of AD.

Significance of an additional unenhanced scan in computed tomography angiography of patients with suspected acute aortic syndrome

AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(AAS).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected AAS were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of IMH.RESULTS Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.

Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes

Acute aortic syndrome(AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection(AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT(MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., "beak sign", aortic "cobwebs" that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the rightdiagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.

Acute Type B Dissection Complicated by Aortic Coarctation

We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a small intimal tear, a true lumen, a false lumen, a markedly thick mural thrombus and pleural effusion. Open surgical procedure was performed and the aortic coarctation (CoA) and aortic dissection were resected and a 24-mm prosthetic graft was anastomosed. No pseudo aneurysms were present at the anastomosis sites on the follow up CTA.

腹主动脉联合常规一站式胸痛三联CTA检查在急性胸痛患者诊疗中的价值

目的 探讨腹主动脉联合常规胸痛三联CT血管成像(triple rule-out computed tomography angiography, TRO-CTA)检查在急性胸痛患者检查中的价值。方法 回顾性纳入1 482例急性非创伤性胸痛患者,414例患者接受传统的TRO-CTA扫描,1 068例患者在临床医师的要求下接受包括腹主动脉的TRO-CTA扫描(TRO-CTAwAA)。两组患者主动脉期的扫描范围不同:常规TRO-CTA只扫描胸主动脉,TRO-CTAwAA扫描整个主动脉,其余所有的扫描参数均相同。采用卡方检验对两组主动脉主要血管异常(主动脉夹层、动脉瘤、穿透性溃疡、壁内血肿、血管闭塞和血栓形成)的检出率进行比较。采用方差分析(ANOVA)对两组辐射剂量(CTDIvol和DLP)和扫描时间进行比较。结果 TRO-CTAwAA组的主动脉异常检出率明显高于TRO-CTA组(35.1%vs. 4.8%,P<0.001)。在TRO-CTAwAA组中,有26.5%的血管异常在胸主动脉和腹主动脉上均可检出,另外8.6%只发生在腹主动脉上。两组间辐射剂量相比,TRO-CTAwAA组的总DLP明显高于常规TRO-CTA(P<0.001)。两组扫描时间对比差别无统计学意义(P=0.410)。结论 腹主动脉联合常规TRO-CTA检查,可显著提高急性胸痛患者主动脉血管异常的检出率,不增加检查流程。

Multislice CT virtual intravascular endoscopy of aortic dissection:A pictorial essay

AIM:To present our experience of using 3D virtual intravascular endoscopy(VIE) to characterize and evaluate the intraluminal appearances of aortic dissection.METHODS:Ten patients with known aortic dissection underwent dual-source computed tomography angiography and were included in the study.In addition to 2D axial and multiplanar reformatted images as well as 3D reconstructions,VIE images were created in each patient to demonstrate intraluminal views of the aorta and its branches,origin of artery branches and artery branch involvement by aortic dissection.RESULTS:Stanford A dissection was found in 8 patients and B dissection in the remaining 2 patients.VIE images were successfully generated in all of the patients with excellent visualization of the normal anatomical structures,intimal flap and intimal entrance tear,communication between true and false lumens,as well as assessment of the extent of aortic dissection.CONCLUSION:Our preliminary experience suggests that VIE could be used as a complementary tool to assist radiologists accurately evaluate aortic dissection so that better patient management can be achieved.

Can post-mortem computed tomography be considered an alternative for autopsy in deaths due to hemopericardium？

Hemopericardium 是在尸体的普通发现，但是当在引起死亡的 etiopathological 关系被请求时，它可以为法庭的病理学家代表挑战。Hemopericardium 和心脏的 tamponade 能用放射学的技术在生活人被评估，特别地计算机断层摄影术(CT ) 。仅仅一些研究在验尸包含的文学(下午) 被报导案例在 PMCT 成像被使用了以便调查尖锐 hemopericardium 的地方，并且他们显示出这种技术的好精确性。这里，我们报导包含在沙滩上发现死了的 70 岁的白男性的一个案例，与有差的药理学回答的丙肝和长期的高血压的病历。PMCT 被执行在身体的发现以后的大约 3 h。PMCT 考试显示出大动脉的解剖联系了到在液体和 clotted 血在于的 periaortic hematoma，塑造镰刀的内部 hematoma，假腔，和 hemopericardium 的 intrapericardial。在这种情况中， PMCT 能识别死亡的原因，尽管一具传统的尸体被要求证实放射学的调查结果。PMCT 是一种可靠技术，它在选择情况中，没有对要执行的一具传统的尸体的需要，能被执行。

使用深度学习在CTA扫描卷下实现主动脉夹层分类和直径测量的双功能系统

Acute aortic dissection is one of the most life-threatening cardiovascular diseases,with a high mortality rate.Its prevalence ranges from 0.2%to 0.8%in humans,resulting in a significant number of deaths due to being missed in manual examinations.More importantly,the aortic diameter—a critical indicator for surgical selection—significantly influences the outcomes of surgeries post-diagnosis.Therefore,it is an urgent yet challenging mission to develop an automatic aortic dissection diagnostic system that can recognize and classify the aortic dissection type and measure the aortic diameter.This paper offers a dual-functional deep learning system called aortic dissections diagnosis-aiding system(DDAsys)that enables both accurate classification of aortic dissection and precise diameter measurement of the aorta.To this end,we created a dataset containing 61190 computed tomography angiography(CTA)images from 279 patients from the Division of Cardiovascular Surgery at Tongji Hospital,Wuhan,China.The dataset provides a slice-level summary of difficult-to-identify features,which helps to improve the accuracy of both recognition and classification.Our system achieves a recognition F1 score of 0.984,an average classification F1 score of 0.935,and the respective measurement precisions for ascending and descending aortic diameters are 0.994 mm and 0.767 mm root mean square error(RMSE).The high consistency(88.6%)between the recommended surgical treatments and the actual corresponding surgeries verifies the capability of our system to aid clinicians in developing a more prompt,precise,and consistent treatment strategy.

Hemothorax Revealing Aortic Aneurism and Aortic Dissection

Hemothorax caused by rupture of aortic aneurysm or aortic dissection is an uncommon manifestation and carries a high mortality rate. We report two cases of 75- and 80-year-old men, who were referred to our department for exploration of a left pleural opacity. Thoracentesis produced a hemorrhagic fluid. The computed tomography scan revealed an aortic dissection type B of Stanford in the first case and an aneurysm of the descending thoracic aorta in the second patient. Emergency operation was performed in the first case but the patient died of multiple organ failure 48 hours after surgery. Aortic dissection or aneurysm can result in a hemothorax especially in patient with favourable conditions such as elderly patient and systemic hypertension. Diagnosis relies on computed tomography (CT) scan and echocardiography.

自动管电压选择技术(CARE KV)对急性胸痛三联征CTA图像质量及辐射剂量影响的研究

目的 探究宽体探测器急性胸痛三联征CTA检查管中,自动管电压选择技术(CARE KV)对图像质量及辐射剂量的影响,探究低辐射剂量在胸痛三联征一站式CTA检查中的应用。方法 收集2020年2月至2021年10月在我院急诊或门诊因胸痛怀疑患有急性冠状动脉综合征、肺栓塞或主动脉夹层的患者90人。所有患者均进行胸痛三联征计算机断层扫描血管造影(CTA)检测。其中45名患者采用了CARE KV技术进行扫描,编为A组;其余45名患者采用常规管电压加自动管电流技术编为B组。对所有的患者冠状动脉、肺动脉及主动脉分别进行进行主观图像质量评价并记录计算所有患者的辐射剂量值;结果 A组冠状动脉共785段(25段未纳入统计),B组冠状动脉共783段(27段未纳入统计),两组冠状动脉主观图像质量在1-3级分别为776段(98.85%)、779段(99.48%);两组肺动脉各1395段,A组评价在1-2级有1358段,B组评价在1~2级有1367段;两组主动脉各135段,两组主动脉评价全部都在1-2级;上述结果两组对比均无显著性差异(P>0.05)整体辐射剂量统计A组显著低于B组,差异有统计学意义(P<0.05)。结论 应用CARE KV与自动管电流技术进行低剂量胸痛三联征CTA扫描,图像质量可满足急性胸痛患者诊断需要,同时显著降低了辐射剂量。

超声及CTA对主动脉夹层Stanford细化分型的诊断价值

目的探讨超声、计算机体层摄影血管造影(computed tomography angiography,CTA)及两者联合对主动脉夹层Stanford细化分型的诊断价值。方法对128例高度怀疑主动脉夹层的患者分别进行超声和CTA检查,并依据Stanford细化分型做出诊断,该分型包括A1、A2、A3型和B1、B2、B3型,其中每个亚型又包括S和C两个亚级;以手术结果为金标准,分别评价超声、CTA及两者联合对主动脉夹层Stanford细化分型的诊断价值。结果①术前超声、CTA及两者联合对夹层细化分型诊断的敏感性分别为76.5%、91.3%、100%;特异性分别为34.5%、0%、34.5%;准确性分别为72.7%、82.0%、93.8%;阳性预测值分别为91.7%、89.0%、93.5%;阴性预测值分别为15.6%、0%、100%;②超声对A1S、A2S、A3S诊断准确率为100%,而对B3C容易漏诊;CTA对A1S、A1C以及所有B亚型诊断准确率为100%,而对A2S、A2C容易误诊;两者结合能明显提高细化分型诊断的准确率。结论超声及CTA对主动脉夹层Stanford细化分型诊断具有重要的诊断价值,两者联合能明显提高诊断的敏感度、准确度、阳性预测值及阴性预测值。

主动脉夹层撕裂内膜走行规律的MSCTA研究

目的观察Stanford A型和Stanford B型主动脉夹层(AD)主动脉腔内的撕裂内膜走行规律。方法回顾性分析65例AD患者的CTA资料,在胸腰椎体和椎间隙层面轴位图像上确定夹层动脉撕裂内膜与管壁两个结合点的位置,并计算真腔所处夹角角平分线(TLIAB)的钟点数。同时观察AD对主动脉分支大血管的影响情况。结果升主动脉段Stanford A型内膜撕裂由主动脉根部向弓部呈顺时针旋转;真腔位于主动脉腔左侧约3~6点位置,TLIAB位置的平均钟点数为4.16±1.51。降主动脉段AD内膜撕裂由近端向远端呈逆时针旋转,Stanford A型和B型撕裂模式大致相同,旋转幅度相似;主动脉弓降部真腔位于主动脉腔右侧,TLIAB位于8~9点,降主动脉远端TLIAB位于7~8点。左冠状动脉均开口于真腔,其钟点数(3.82±0.41)与对应层面TLIAB(3.69±0.82)差异无统计学意义(t=0.86,P=0.40);右冠状动脉开口紧邻血管壁内膜撕裂处。Stanford A型和B型AD的降主动脉段分支血管起源部位分型差异均无统计学意义(P均>0.05)。结论AD内膜呈螺旋状撕裂,升主动脉段由主动脉根部至弓部呈顺时针旋转,降主动脉段由弓降部至远端呈逆时针旋转且Stanford A、B型的旋转模式大致相同。Stanford A型和B型AD主动脉分支大血管的受累情况相似。

孤立性外周动脉夹层与主动脉夹层CTA影像学对比研究

目的:探讨孤立性外周动脉夹层与主动脉夹层的不同影像学特点。资料与方法:回顾性分析22例孤立性外周动脉夹层和25例主动脉夹层患者的CTA图像,对比其影像学特征。结果:主动脉夹层和孤立性外周动脉夹层CTA图像均可清晰分辨真腔、假腔及夹层累及动脉长度。两组大部分患者伴有不同程度动脉硬化表现。两组间比较,假/真腔比值、动脉受累长度、动脉硬化发生率组间差异有统计学意义,P<0.05。结论:孤立性外周动脉夹层往往在动脉粥样硬化基础上发生,受累动脉局限,真腔往往大于假腔,病情相对稳定,其影像学表现与主动脉夹层存在明显不同。

经胸超声心动图及CTA诊断Stanford A型主动脉夹层的价值

目的 评价经胸超声心动图(transthoracic echocardiography,TTE)、CT血管造影(computed tomography angiography,CTA)在诊断Stanford A型主动脉夹层(aortic dissection,AD)中的临床价值。方法 对22例Stanford A型AD患者的TTE、CTA检查结果及手术、病理进行回顾性分析。结果 TTE、CTA诊断Stanford A型AD与手术符合率分别为90.9%、95.5%,两者比较差异无统计学意义(P>0.05)。TTE的优势在于观察升主动脉近端病变、瓣膜反流及其严重程度及评估心功能、心包积液量。CTA的优势在于显示AD累及范围,尤其显示主动脉弓、胸腹主动脉、冠状动脉病变均优于TTE(P<0.05)。结论 TTE、CTA诊断AD各有优势,联合应用对AD诊疗方案的选择具有重要价值。

主动脉夹层发生前主动脉管壁厚度的CTA初步研究

目的:在主动脉夹层(Aortic dissection,AD)形成前,探索是否存在CT血管造影(CT angiography,CTA)可检测到的主动脉变化,初步探讨其在AD发生中的诊断价值。方法:回顾性分析2012年1月—2019年12月在我院就诊、且既往已行CTA检测的夹层病例纳入AD组,与AD组相匹配的非夹层病例纳入对照组。通过CTA影像测量各病例的夹层相关管壁厚度(dissection-related wall thickness,D-T)、夹层无关管壁厚度(non-dissection-related wall thickness,non-D-T)和对照管壁厚度(control wall thickness,C-T),并分别比较上述指标在组内和组间的差异。结果:本研究共纳入70例患者,其中33例在发展为AD之前接受过CTA检测,纳入AD组;37例接受CTA检测但未发展AD,纳入对照组。AD组自身对比,D-T值大于non-D-T值,且有统计学意义((2.20±0.18)mm vs(1.61±0.12)mm;P<0.01);AD组与对照组组间对比,D-T值大于C-T值且有统计学意义((1.57±0.17)mm;P<0.01)。亚组分析表明,交通性AD组的D-T值小于伴溃疡样凸起的非交通性AD组,且有统计学意义((1.85±0.29)mm vs(2.57±0.31)mm;P<0.01)。结论:主动脉壁增厚可能早于AD发生,通过CTA测量相关数据,对于早期诊断AD有重要意义。

64排螺旋CTA在主动脉夹层中的诊断价值

目的探讨64排螺旋CT血管造影技术(CTangiography,CTA)及各种图像重建技术在主动脉夹层(AD)中的诊断价值。方法对41例AD患者行64排螺旋CTA扫描,将原始图像行多平面重建(MPR)、曲面和管腔拉直图(CPR和LS)、最大密度投影(MIP)、仿真内窥镜(VE)、容积再现(VR)重建。结果典型主动脉夹层(TAD)共35例,其中DeBakeyⅠ型、Ⅱ型、Ⅲa型、Ⅲb型各5、2、4、24例;不典型主动脉夹层(AAD)共6例。TAD患者中,35例均可显示真假腔、内膜片及分支血管受累情况,33例患者见初始破口,21例患者假腔内见血栓。轴位、MPR、CPR和LS是显示TAD的最好手段,MIP次之,VR可立体显示血管,VE可观察到破口的内部形态。结论 64排螺旋CTA及多种重建方法的应用能快速、无创、准确地诊断可无创性准确诊断各种主动脉夹层,为临床选择治疗方案提供更多的信息。

256层MSCTA对急性主动脉综合征的诊断价值分析

目的 探讨256层螺旋CT血管成像(MSCTA)对急性主动脉综合征(AAS)的诊断价值。方法 收集91例急性主动脉综合征患者的临床及影像资料,对MSCTA图像表现进行分析。结果 91例AAS患者中68例主动脉夹层,其中StanfordA型28例,B型40例,CTA不仅能清晰显示真假腔结构、内膜破口和移位的内膜片,也可以对假腔内血栓、上纵隔或心包积血进行评价,与DSA诊断结果一致。主动脉壁间血肿12例,StanfordA型2例,B型10例,5例可见钙化内膜移位,2例内壁可见溃疡形成,3例表现为内膜渗漏。主动脉粥样硬化性穿透性溃疡8例,共有23处病灶,位于主动脉弓6处,降主动脉15处,髂总动脉2处。不稳定的胸主动脉瘤3例,2例患者瘤体内可见壁内血肿和附壁血栓形成,1例瘤体外见到少量对比剂渗出。结论 MSCTA能对AAS进行准确的诊断和鉴别诊断,为临床治疗和术后评估提供关键的依据。

双源CT三维血管成像(3D-CTA)在主动脉夹层诊断中的应用价值

目的评价双源CT(DSCT)三维血管成像在主动脉夹层诊断中的应用价值。方法收集45例临床怀疑主动脉夹层行双源CT主动脉成像患者。分析其3D-CTA影像表现,并与其他影像学检查结果进行对照。将原始数据在工作站进行MPR,SSD,M IP及VR等后处理。45例中有36例同时行超声检查。17例行DSA检查。7例行MRA检查。结果 45例患者共检出主动脉夹层34例,均很好地显示了主动脉全程及其分支,真腔、假腔、内膜片及夹层动脉瘤的部位、范围得到满意显示,主动脉瘤2例,主动脉壁内血肿3例,肺动脉栓塞2例,正常4例。DSA与MRA检查结果与CTA基本一致。结论双源CT三维血管成像能够快速而准确地进行主动脉的无创性检查,与其它方法相比,是诊断主动脉夹层的首选影像学检查方法。

胸腹血管CTA在胸腹主动脉夹层诊断价值中的研究

目的探讨胸腹血管多层螺旋CT血管成像(CTA)对主动脉夹层的诊断及临床分型中的价值。方法回顾分析2009年1月—2013年9月在该院影像科接受检查的50例主动脉夹层患者,使用多层螺旋CT胸腹主动脉联合扫描,根据手术结果评价诊断结果,计算灵敏度及特异度,并对不同CTA扫描方式对诊断结果的影响进行分析。结果 50例主动脉夹层患者进行最大密度投影(MIP)、多平面重建(MPR)、容积重建(VRT)等后处理,48例较好地显示了真假腔和主动脉夹层内膜瓣、破口位置和分支血管受累情况。胸腹血管CTA诊断的敏感度96.0%,特异度96.0%,与手术探查比较没有显著性差异(P>0.05),单因素分析发现扫描方向、对比剂用量对诊断结果的影响有显著性差异(P<0.05),回归分析发现,足—头侧扫描及对比剂用量90 mL的影响具有显著性差异(P<0.05)。结论胸腹血管CTA对主动脉夹层的诊断与手术探查具有较好的一致性,且敏感度、特异度高,诊断结果主要受扫描方式及对比剂用量的影响,临床可根据患者情况合理调整诊断模式。