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目的:总结主动脉夹层的CT与临床表现,提高其诊断水平。方法回顾性分析37例主动脉夹层患者的CT与临床表现及部分患者的预后随访。结果 37例患者平扫见主动脉明显增粗,多数腔内密度均匀,部分管腔内可见弧形钙化影;增强后见线状低密度内膜片将主动脉分隔为双腔;真腔较小,呈半圆形、卵圆形;假腔较大,呈半圆形或新月形;真假腔可相对平行,假腔也可盘绕真腔自左向右、自上而下呈螺旋状。平扫时真腔与假腔多为等密度,增强后真腔密度较假腔略高或等密度。当假腔呈螺旋型盘绕真腔时,内膜片也呈螺旋状走行;6例假腔内有不同形状的血栓,其中2例假腔完全被血栓填塞。16例患者有动脉粥样硬化。主动脉弓部及腹主动脉主要分支血管无受累表现;37例患者双肾血流灌注正常。3例患者双侧髂总动脉受累。8例夹层血管周围局限性肺不张。10例合并胸腔积液。本组分型采用DeBkey法分型:I型14例;Ⅱ型4例;Ⅲ型19例。结论 CT可对主动脉夹层做出明确诊断。能为临床的治疗方案提供依据。
Objective: To summarize the CT and clinical manifestations of aortic dissection and to improve its diagnostic value. Methods A retrospective analysis of 37 patients with aortic dissection CT and clinical manifestations and prognosis of some patients were followed up. Results In 37 cases, the aorta was obviously thicker, the density of most of the cavities was uniform, and the arcuate calcification was seen in some of the cavities. After the enhancement, linear low density intima was found to divide the aorta into double cavities. Small, semicircular, oval; false cavity larger, semi-circular or crescent; true and false cavity can be relatively parallel, the false cavity can also be coiled true cavity from left to right, spiral from top to bottom shape. Echocardiography and false lumen when the scan is mostly equal density, enhanced true cavity density slightly higher than the false lumen or isodense density. When the fake cavity was spiral-shaped, the inner membrane also traveled spirally. In 6 cases, there were different shapes of thrombus in the fake cavity, of which 2 cases were completely filled with thrombus. 16 patients had atherosclerosis. Aortic arch and the main branch of the abdominal aorta vessels without involvement of performance; 37 patients with normal renal perfusion. Three patients had bilateral common iliac artery involvement. 8 cases of dissecting peripheral vascular limitations of atelectasis. 10 cases with pleural effusion. This component type using the DeBkey method: 14 cases of type I; 4 cases of type Ⅱ; 19 cases of type Ⅲ. Conclusion CT can make a clear diagnosis of aortic dissection. Can provide the basis for clinical treatment programs.