主动脉急症的CT诊断课件.ppt

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主动脉急症的CT诊断;内容; AORTIC DISSECTION主动脉夹层;Classification 分类;Type A: 90% die within 3 months if not treated urgent operation Type B: medications or interventional treatment;Chest Radiographic Findings 胸片表现; Role of MDCT angiography 动脉CTA作用;Unenhanced CT 平扫;Classification: Stanford type A ;Stanford type B;False lumen Larger cross sectional area ( Pfalse ≥ Ptrue ) Delayed enhancement/ thrombosis Beak sign;Cobweb sign True lumen: its continuity with an undissected portion of the aorta;Complications of Thoracic AD并发症;Complications of Abdominal AD并发症;Malperfusion灌注不良;Branch Vessel Obstruction分支血管阻塞;Dynamic occlusion:动态闭塞 - true lumen resembles a C-shaped envelope that is predominantly concave toward the false lumen - treated with a fenestration procedure ;Static occlusion:静态闭塞 - intimal flap intersects or enters the branch-vessel origin - treated locally with an intravascular stent ;陷阱Pitfalls of MDCT;ECG-gated Vs. Non- ECG-gated ;;How to write report;INTRAMURAL HEMATOMA 壁间血肿;Precontrast CT, narrow window “Hyperattenuating crescent” on precontrast CT No contrast enhancement, smooth margin 30% rate of progression to overt aortic dissection ;Subacute Intramural Hematoma 亚急性壁间血肿;Differentiation of acute IMH from mural thrombus or thrombosed false lumen seen in AD ;AD false lumen thrombosis: multilayered pattern of increasing attenuation intimal flap (when you scroll up and down..) ;Natural history of IMH;Can resolve:followed 2 months.;(a) Unenhanced axial CT image obtained at presentation depicts a type B aortic intramural hematoma (arrow). (b) Contrastenhanced axial CT image obtained 1 month later shows an enhancing ulcerlike projection (arrow), a finding suggestive of a new intimal tear. (c) Contrastenhanced axial CT image obtained 2 months later shows overt dissection(arrow). ;Can progress to fusiform aneurysm… 可进展为梭形动脉瘤; F/70 acute chest and upper back pain;Observation acute chest pain;Differential Diagnosis鉴别诊断; F/23 pa

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