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双源CT血管成像技术在AIMH诊断及EVE术后随访中的临床应用价值

Clinical Value of Dual-source CT Angiography in the Diagnosis of Postoperative Aortic Intramural Hematoma in

  • 摘要: 目的 探讨双源CT血管成像技术 (dual-source CT angiography, DSCTA)在主动脉壁内血肿 ( aortic intramural hematoma,AIMH)诊断及腔内支架隔绝 (endovascular stent-graft exclusion,EVE)术后随访中的临床应用价值。方法 2008年10月至2013年5月间,36例患者经DSCTA检查诊断为AIMH,其中12例Stanford B型患者EVE术后行DSCTA随访观察。在工作站上完成患者的图像重建及分析工作,重建技术包括多平面重组 (MPR)、最大密度投影 (MIP)及容积再现技术 (VRT)等。壁内血肿患者重点观察血肿CT表现、血肿累及范围并分型、是否并发主动脉壁溃疡等,EVE治疗患者则重点观察血肿转归及并发症情况。结果 36例AIMH包括Stanford A型11例、Stanford B型25例。所有患者血肿区域均未见撕裂内膜片显示及对比剂进入血肿内。血肿部位主动脉最大直径3.8~5.4 cm (平均4.3 cm),血肿最厚径0.5~1.3 cm (平均0.9 cm),血肿最厚层面主动脉腔最小直径/最大直径比值为0.74~0.98 (平均0.85)。3例Stanford A型、8例Stanford B型可见到一个或多个溃疡形成,3例Stanford B型患者并发腹主动脉远端内膜撕裂。12例EVE治疗患者术后血肿均有不同程度缩小,4例血肿基本吸收,3例支架覆盖区溃疡消失。9例患者支架形态正常,3例支架稍变形。所有患者未见支架内漏,大分支血管通畅。结论 DSCTA检查具有操作简便、准确性高且无创等优点,可以作为AIMH诊断及EVE术后随访重要的影像学方法。

     

    Abstract: 【Abstract】 Objective To determine the value of focal area of ground-glass opacity (fGGO) for early detection and diagnosis of lung cancers. Methods We reviewed clinical data of all patients whose chest CT images showed isolated lesions ≤5 cm in diameter in the Department of Chest Surgery at West China Hospital, Sichuan University between 2007 and 2010. According to the volume of solid components, the lesions were classified as pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) or solid lesions. The malignant ratio and stage of lesions were calculated based on the postoperative pathological tests. The characteristics of CT signs were compared between the benign and malignant lesions. Results Of the 202 cases, 63 (included 15 pGGO and 48 mGGO) had fGGO with a malignant ratio of 71.4% (45/63). The percentage of malignant tumors in the mGGO, pGGO and solid lesions was 75.0%, 60.0% and 48.2% respectively. Stage Ⅰ lung cancers had an occurrence of spiculation, lobulation and vascular convergence in fGGO of over 70%, higher than that of the benign tumors (P<0.05). Conclusion fGGO is an important indicator of lung cancer. mGGO is highly likely to be malignant, particularly when one or more signs of spiculation, lobulation and vascular convergence appear.

     

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