主动脉夹层撕裂内膜走行规律的MSCTA研究

发布时间：2018-04-07 17:23

本文选题：体层摄影术　切入点：X线计算机　出处：《中国医学影像技术》2017年01期

【摘要】：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。
[Abstract]:Objective to observe the pattern of intra aortic laceration in Stanford A and Stanford B aortic dissection.Methods the CTA data of 65 patients with AD were analyzed retrospectively. The location of the two junction points between the intima and the wall of the dissecting artery was determined on the axial images of thoracolumbar vertebral body and intervertebral space, and the clock points of the angle of the true cavity were calculated.At the same time, the influence of AD on aorta branches was observed.Results the Stanford A intimal tear of ascending aortic segment was rotated clockwise from the root of the aorta to the arch, and the average number of hours of the true cavity was 4.16 卤1.51 in the left side of the aortic cavity at about 3 ~ 6 o'clock in the position of TLIAB.The AD intimal tear of descending aortic segment was rotated counterclockwise from proximal to distal end, and the pattern of A and B tears was similar, and the true cavity of descending part of aortic arch was located at TLIAB at 89 points on the right side of aortic cavity.The distal TLIAB of descending aorta was located at 8 o'clock.The left coronary artery was open in the true cavity.There was no significant difference in the number of hours (3.82 卤0.41) and the corresponding level (TLIAB(3.69 卤0.82). There was no significant difference in the origin of descending aorta branches between the right coronary artery openings adjacent to the intimal tear of the wall. There was no significant difference in the origin of the descending aorta branches between the right coronary artery openings and the type A and B AD.Conclusion the intima of AD is spirally torn and the ascending aortic segment rotates clockwise from the root of the aorta to the arch.The descending aortic segment rotated counterclockwise from the descending part of the arch to the distal end, and the pattern of Stanford A type B rotation was similar to that of Stanford A type A and B type AD aortic branches.
【作者单位】：包头市第八医院医学影像科;内蒙古医科大学附属医院影像诊断科;
【基金】：内蒙古自治区卫生和计划生育委员会科研项目(201301050)
【分类号】：R543.1;R816.2

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