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目的 评价电子束CT(EBCT)在主动脉不典型夹层诊断中的临床应用。方法 1994年5月至 2 0 0 0年 4月 15 0 0 0例EBCT检查中诊断主动脉夹层 2 63例 ,其中 2 5例为不典型夹层。男 2 1例 ,女 4例。全部患者均以主诉急性胸痛入院检查。采用Imatron 15 0 XP型EBCT扫描机 ,连续容积增强扫描 ,层厚 3mm ,扫描时间为 0 1s。扫描范围自主动脉弓水平至左右髂动脉分叉处 ,共 14 0层。结果不典型夹层EBCT血管造影 (EBCTA) :直接征象为 :( 1) 2 5例主动脉壁均呈半月状或环状增厚 ,达 5～2 3mm ,平均 15 3mm ,无内膜破裂形成的双腔主动脉征象 ,CT值 5 0～ 87HU ,累及长度为 2 5～4 9 0cm ,平均 16 3cm ;( 2 )内膜钙化移位 5例 ;( 3 ) 6例治疗后EBCT随访 ,管壁厚度呈动态变化。间接征象为 :( 1)主动脉壁增厚溃疡形成 7例 ;( 2 )动脉粥样硬化性改变 12例。上述征象结合临床急性胸痛病史 ,诊断可以成立。病变累及升主动脉 (StanfordA型 ) 6例 ;仅累及降主动脉 (StanfordB型 ) 19例。全部病例临床均采取保守治疗 ,其中 6例EBCT复查 ,3个月至 1年血肿吸收。结论 急诊胸痛鉴别诊断中EBCT对主动脉不典型夹层诊断是一种无创、安全、有效的诊断方法 ,且便于治疗后随诊观察
Objective To evaluate the clinical application of electron beam computed tomography (EBCT) in the diagnosis of aortic atypia. Methods A total of 263 cases of aortic dissection were diagnosed in 150 cases of EBCT from May 1994 to April 2000, of which 25 cases were atypical dissection. Male 2 1 cases, 4 females. All patients were admitted to hospital for acute chest pain. Using Imatron 15 0 XP EBCT scan machine, continuous volume enhanced scan, layer thickness 3mm, scan time 0s. Scan range of autonomic aortic arch to the left and right iliac artery bifurcation, a total of 14 0 layers. Results of atypical dissection EBCTA: direct signs as follows: (1) 25 cases of aortic wall showed semilunar or annular thickening, up to 5 ~ 23mm, an average of 15 3mm, no rupture of the endometrium The signs of double-aortic aorta were CT scan of 50 ~ 87HU and length of 25 ~ 49 0cm with an average of 16 3cm. (2) Intimal calcification transposition in 5 cases. (3) Six cases of EBCT were followed up, Thickness showed dynamic changes. Indirect signs are: (1) aortic wall thickening ulcer in 7 cases; (2) atherosclerotic changes in 12 cases. The above signs combined with clinical history of acute chest pain, diagnosis can be established. Lesions involved in ascending aorta (Stanford A type) in 6 cases; only involving the descending aorta (Stanford B type) in 19 cases. All cases were treated conservatively, including 6 cases of EBCT review, 3 months to 1 year of hematoma absorption. Conclusion EBCT is a noninvasive, safe and effective method for the diagnosis of atypical atherosclerosis in the emergency diagnosis of chest pain. It is easy to be followed up after treatment