摘要
目的探讨CT对主动脉夹层(aortic dissection,AD)诊断的影像学特点及AD破裂或慢性渗漏时CT表现和诊断价值。方法 27例患者24例有高血压史。全部患者均作CT平扫和增强扫描,并作表面阴影显示(SSD)及二维多平面重建(2DMPR)。结果按DeBakey分型:Ⅰ型3例,Ⅱ型8例,Ⅲ型16例。平扫显示点片状钙化内膜片内移11例,增强扫描后查见真、假2腔27例,其中2例真腔外侧血管壁又有撕裂呈3个腔2个内膜片。AD撕裂内膜呈螺旋形上下伸展。不强化之附壁血栓位于假腔8例,真、假腔均有5例。5例急性或慢性AD破裂渗漏均有主动脉周积液或轮廓不规则,2例胸主动脉夹层伴有纵隔、心包和双侧胸腔积液,3例腹主动脉夹层有弥漫性腹膜后纤维化,双腰肌、肾周间隙有网束影,形态不规则,双侧肾旁筋膜增厚。结论 CT扫描对AD及其并发症的诊断以及其病理特征的显示具有重要价值。AD慢性渗漏所致腹膜后纤维化有其独特表现与特发性腹膜后纤维化有所不同。
Objective To investigate the imageological characteristics of CT for diagnosing aortic dissection(AD),CT manifestations and diagnostic value of AD rupture or chronic leakage.Methods 27 cases of AD were included,All cases were performed plain and enhanced CT scanning,and two-dimensional multiple shaded surface display(SSD) and two-dimensional multi-planar reconstruction(2DMPR).Results According to the DeBakey classification,type I was in 3 cases,type II in 8 cases and type III in 16 cases.In plain CT scanning,11 cases showed inward shifting of dot-like and flake-like calcification intimal flap.27 cases revealed the true and false two cavities after enhanced CT scanning.Among them,2 cases showed 3 cavities and 2 intimal flaps with lateral vessel wall tearing in true cavity.The tearing intima was stretched upward or downward with spiral-like pattern.8 cases manifested by nonenhanced mural thrombus located in the false cavity and 5 cases had mural thrombus both in true and false cavities.5 cases of acute or chronic AD rupture and leakage all had aortic peripheral effusion or irregular contour.2 cases of thoracic AD were complicated by mediastinal,pericardial and bilateral pleural effusions.3 cases of abdominal AD showed diffuse retroperitoneal fibrosis,nets beam shadow in the bilateral lumbar muscles and perirenal spaces,with irregular shape and thickening perirenal fascia.Conclusion CT scanning reveals the important value to diagnose AD and its complications,and manifest its pathologic characteristics.Retroperitoneal fibrosis caused by chronic AD leakage has unique manifestations,which is different from idiopathic retroperitoneal fibrosis.
出处
《现代医药卫生》
2012年第2期186-187,共2页
Journal of Modern Medicine & Health