主动脉夹层影像表现医学课件.ppt

2.CT表现 CT平扫 可显示主动脉扩张；发现内膜钙化优于X线平片 钙化内膜向中央移位 主动脉夹层 向外围移位 单纯主动脉瘤 CT增强扫描（CTA） 真腔 腔窄，充盈对比剂快 主动脉夹层 内膜片 假腔 腔大，充盈双比剂慢 显示内膜破口及主要分支受累情况、假腔内血栓、主动脉夹层血液外渗、纵隔血肿等。 3D或VRT显示累及范围，并观察主动脉瓣和左室功能。 CT平扫示降主动脉钙化内膜向中央移位 主动脉内可见撕裂的内膜片和较小的真腔 CTA三维成像，显示为哪一型主动脉夹层？ 主动脉夹层CTA 重建彩图 主动脉夹层CTA 重建彩图 3.MRI表现 可不用对比剂即能全面评价主动脉夹层，其表现与CTA所见相似，但目前图像质量不如CTA。 ①真腔与假腔：信号强度不同，亦可相同，两者之者为线状的内膜片，并沿主动脉长轴延伸，真腔多小于假腔 ②内膜破口：内膜片连续性中断，电影MRI序列可见破口处血流往返或见假腔侧的血流信号喷射现象； ③夹层范围：MR能明确夹层范围，进而分型并观察与主动脉分支关系； ④并发症：如主动脉瓣关闭不全、左心动能不全、心包及胸腔积液、假性动脉瘤等 主动脉夹层MR图像 * * 主动脉夹层MRI * * 再见 The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University The First Affiliated Hospital Zhejiang Chinese Medical University 主动脉夹层影像表现 主动脉夹层 主动脉夹层为主动脉壁内膜损伤后，腔内的血液通过内膜破口进入主动脉壁撕裂中层而形成腔隙。 病理与临床: 主动脉血液经内膜破裂口进入主动脉壁中层并在动脉壁内扩展延伸，形成“双腔”，在远侧发生再破口，使假腔内血液再回流到主动脉腔（真腔）内。 DeBakey将主动脉夹层分为3型： Ⅰ型起自升主动脉并延至降主动脉. Ⅱ型局限于升主动脉. Ⅲ型起自降主动脉并向远